Inspection on 11/07/06 for 151 Tunbury Avenue

This inspection was carried out on 11th July 2006.

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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

151 Tunbury Avenue 20/01/10

151 Tunbury Avenue 01/10/07

151 Tunbury Avenue 15/12/05

151 Tunbury Avenue 28/06/05

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Southfields

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

CARE HOME ADULTS 18-65 151 Tunbury Avenue 151 Tunbury Avenue Chatham Kent ME5 9HY Lead Inspector Jo Griffiths Unannounced Inspection 11th July 2006 11:00 151 Tunbury Avenue DS0000064404.V298854.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 151 Tunbury Avenue DS0000064404.V298854.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. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 151 Tunbury Avenue Address 151 Tunbury Avenue Chatham Kent ME5 9HY 01622 769100 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) MCCH Society Limited Care Home 3 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (1) of places 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/12/05 Brief Description of the Service: 151 Tunbury Avenue is one of a number of homes managed by MCCH Society Ltd. The home offers 24-hour care for service users with a learning disability and can accommodate people with a physical disability. It is a large detached bungalow located within a pleasant residential area. The home benefits from transport that is shared between several homes from that group. The fees charged for this service start at £1287 per week and are based on an assessment of individual need. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. The inspector visited the home between 11.00am and 6.00pm on 11th July 2006. The Manager was present. Some of the service users were spoken with about what it is like to live at the home and some records were seen. What the service does well: What has improved since the last inspection? What they could do better: Service users’ assessment of needs must be kept under review and their needs at night assessed. The Manager must ensure that the night staffing cover meets these assessed needs. The new individual plans must be completed. Service users must be issued with a contract for the service they receive. The service users must be able to access the garden without going through one service users bedroom. This does not respect their privacy. The bathroom, kitchen and laundry facilities must be made safe and accessible for service users as assessed by the Occupational Therapist. The safety restraint that is used in the bathroom must be properly assessed. It must be professionally fitted only if it is still needed after the assessment. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 6 Some minor changes are needed to medication records. The service users must be provided with scales that they can use to monitor their weight. This is particularly important for the service user who needs to set his pressure relief mattress by his weight. It is recommended that the new Manager complete the NVQ4 award in management and care. It is also recommended that he undertake some training in nutrition to help him assess service users nutritional needs. 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. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 5 Service users are given the information they need to make a decision about moving to the home. Service users have their needs assessed but the assessment of needs must be kept under review. Service users do not have a contract for their care. This is being addressed by MCCH. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: The Statement of Purpose has been updated. The service users guide is up to date and has been read to the service users to help them to understand it. Service users had their needs assessed before moving to the home. The assessment of their needs is currently under review as a new system for individual planning is being introduced. These must be reviewed and updated a soon as possible to ensure service users needs are fully met. Service users do not have a contract for their care. MCCH are looking to address this issue in all of their homes. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 9 Service users do not have a completed individual plan, but these are in progress. Service users are supported to make decisions in every day life. Service users are supported to take reasonable risks. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users do not have a fully up to date individual plan at present. This is because MCCH are changing the way the plans are laid out with service users. The new plans will allow the service users to be more involved in developing their goals. These have been started but there is still a lot of work to do to get them completed. This must be a priority for the staff team to ensure that service users receive the support they need. Service users should be encouraged to sign their care plans to show their agreement where they can. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 10 Service users are encouraged to make decisions in their lives. For two of the service users a regular meeting is held between them and their keyworker at their request. At these meetings the service users can request activities they would like to do, discuss any ideas or concerns and share their views about the home. One service user does not have these meetings, as she does not communicate verbally. The Manager should look at other ways to help her express her views. Service users are supported to decide what to eat, what to wear and how to spend their time. Person centred planning is used with one service user to help identify their hopes and dreams for the future. This is working well and it is hoped to open this up to other service users in the future. Risk assessments have been completed for most activities and for areas of risk in the home. These have been kept up to date. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16, 17 Service users are supported to take part in appropriate activities within the local community. Service users are supported to maintain contact with family and friends. Service users do not have their rights fully respected due to the design of the building. They are aware of their responsibilities within the home. Service users enjoy a varied diet. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users have a timetable of their preferred activities for the week. These are flexible so that the person can decide daily what they wish to do. The Manager said that activities had improved since recruitment for staff had been successful. Service users enjoy a number of social clubs and groups linked with 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 12 the local church. All service users are supported to go to town weekly to do their banking and purchase any personal items. Service users are supported to maintain contact with their family and friends and to build new relationships. The Manager has been working with one service user to help them to make contact with family members again. The service users get on well in the home and do some activities together. Service users rights are generally respected, however, the privacy of one service user is not being respected. The only access to the garden for all service users is to go through one service users bedroom. Whilst the service user has said they do not mind this, they should not be the position that they have to agree to this arrangement. The housing provider should be contacted to review wheelchair accessibility to the garden. Service users are encouraged to take responsibility for their own laundry and cleaning of their bedroom where they can. Service users have a 4-week menu that offers a balanced diet. The menu is flexible to allow service users to make choices. It is recommended that the Manager undertake some training in nutrition to allow him to monitor whether service users are receiving a healthy and nutritious diet. Service users nutritional needs should be assessed. Service users spoken with said, when asked, that they liked the food. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, 20 Service users personal care needs are mostly met, but there was no evidence to show that sufficient staff are on duty at night to meet their needs. Service users health needs are met. Service users are protected by the homes procedures for managing medication. Some minor changes are required. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users personal care needs are identified in their individual plan. The risk assessments for some service users state that they require 2 members of staff to help them use the hoists. There is currently only 1 sleep in member of staff on duty from 10pm until 7am and this could mean service users have to wait for support to arrive before they can be helped to move. Service users said they get the help they needed most of the time, but one service user commented that there can be a wait if staff are supporting other people in the house. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 14 Service users health needs are met by the GP and various health specialists. Clear records are kept of all appointments. The protocol for administering Stesolid to a service user must state at what point during the seizure it will be given. Some medicines have been prescribed to be given “as required”, but are being used daily. These should be reviewed with the GP. Medication is stored securely within a locked cabinet. Medication is counted in and recorded on the M.A.R sheet and can be easily audited, this includes PRN medication. All staff have completed or are booked to attend Medication training. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 the following standard(s): 22, 23 Service users know how to make a complaint if they need to. Service users are protected from abuse. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users spoken with said they knew how to complain. They had been issued with a copy of the complaints procedure, but not all had kept it. It is recommended that a copy be clearly displayed in the home for service users and visitors. Regular service user meetings are held for 2 of the service users and they are supported to express their views and concerns. Methods for enabling the other service user or their advocate to complain should be investigated. There have been no complaints received by the home. Most staff have received training in the Protection of Vulnerable Adults. Training should be arranged for the member of staff who has not yet completed it. The Manager is aware of the local multi agency adult protection policy and the MCCH procedure. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 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 the following standard(s): 24, 25, 26, 27, 28, 29, 30 Service users benefit from a safe and comfortable environment. Service users bedrooms promote their independence and meet their needs. Service users bathrooms do not currently meet their assessed needs. Service users have adequate communal space, but do not have appropriate access to the garden. Service users do not have all the specialist equipment to meet their needs. The home is not meeting hygiene standards due to the laundry location. The overall outcome in this area is poor. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users generally benefit from a comfortable and homely environment and those spoken with said they were happy with their home. Each person has his or her own bedroom. The Manager stated on the pre inspection documents 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 17 that 2 of the bedrooms are below the recommended standard of 12sq metres. However, the service users said they are happy with their rooms and the bedrooms are meeting their needs. If any new admissions are made to the home the Manager should consider that it is recommended that people that use wheelchairs are accommodated in bedrooms over 12sqm in size. There is a large assisted bathroom for use by all 3 service users. The Manager said at the previous inspection that plans were in place to renovate the bathroom and to add a walk in shower. It was also stated that an Occupational Therapist (OT) had been involved in the plans and had made recommendations for the changes based on the needs of the service users. The Manager was waiting for funding for the work to be agreed. It was disappointing to see that there had been no further progress with these plans and the new Manager was not aware of the proposed timescales for this work. Currently this leaves one service user with an ensuite shower room that cannot be used, as it does not meet her needs. Whilst she can use the bath this issue should be addressed to offer the choice of bath or shower. The Manager must ensure that a risk assessment is in place for the redundant shower to meet the relevant water regulations and guidelines on legionnaires disease. The toilet in the main bathroom had a handling belt attached; the Manager said this was used to prevent service users from falling from the toilet. This had not been assessed and the restraint in place was makeshift. The Manager must ensure this is removed and an appropriately qualified person, for example an OT completes an assessment of the risks. An appropriate safety restraint should then be fitted only if the assessment identifies it is needed. The care plan for one service user states that his pressure relief mattress must be set to his weight every week. This has not been happening due to a lack of appropriate scales for him to use. An occupational therapist has assessed the service user and has recommended some platform scales. These have not been purchased. The garden is spacious and generally well maintained although service users would benefit from some attention being given to the plants and shrubs to make the garden a more attractive place to use. As described under standard 16 the only access to the garden for service users is through another service users bedroom. The kitchen is clean and well maintained but is not designed with the service users independence in mind. The current residents of the home are wheelchair users and therefore they would benefit from lowered work surfaces and appliances. The Manager stated that plans were in place to modernise the kitchen and it is recommended that consideration be given to making it more user friendly at this time. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 18 It was reported at the last inspection that plans were in hand to address the infection risks presented by soiled laundry being taken through the kitchen to the washing machine. Again, there has been no progress made with regard to these works. Within the restraints of the building, the home is generally kept clean and homely. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 Service users are supported by competent and qualified staff. Service users are supported by an effective team but would benefit from a review of the support available at night. Service users are supported by trained staff. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: There are sufficient numbers of staff on duty during the day to meet the needs of the service users. The home now has one member of staff on a “sleep in” duty instead of a waking night. The Manager stated that this meets the needs of the service users, but it was not evident that an assessment of their needs at night had been completed before this change was made. 2 service users individual plans state that they require 2 staff to help them to mobilise, which could present problems during the night. The records of 1 service user indicated that he had some disturbed nights. Whilst a risk assessment has been completed for staff on sleep in duties it does not address the needs identified in the individual plans. The Manager must ensure that service users 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 20 nighttime needs are fully assessed and that staff cover at night is reviewed based on the assessments. Staff were observed during the visit to interact in a respectful and positive way with service users. Service users spoken with said they liked the staff. The staff spoken with were able to demonstrate a good understanding of the needs of the people they are supporting. Staff training has improved since the last inspection. Staff have completed a number of courses and have booked to attend updates as needed. The Manager must ensure that all staff have received some form of training in adult protection. 60 of the staff team have achieved their NVQ. This exceeds the minimum standard and is very positive for service users. Standard 34 will be assessed by the Provider Relationship Manager later this year. Reference to this will be included within the next report. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Service users benefit from a competent Manager, but do not have the reassurances that the Manager has been registered. Service users are consulted on their views. Service users health and welfare are generally protected in the home. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: A new Manager is in post, but has not yet applied for registration with CSCI. The Manager has a number of years experience working with people with learning disabilities and is currently undertaking the NVQ4 in care. It is intended that once this is complete he will begin the NVQ4 in management. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 22 Service users are consulted on their views of the home through the residents meetings. It is planned that they will be offered the opportunity to complete a satisfaction survey but these have not yet been introduced. The Manager monitors quality in the home through records, supervision and team meetings. MCCH carries out monthly visits to the home and questionnaires are given to visitors, but there is not a formal policy in place for quality assurance in the home. Generally health and safety risks to service users have been assessed. The fire extinguisher checks are now being recorded and the hoists have been serviced. There is some risks to service users from the current laundry arrangements. All staff have completed training in health and safety. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 23 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 2 3 x 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 1 29 2 30 1 STAFFING Standard No Score 31 x 32 4 33 2 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 x 2 x x 2 x 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 24 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 YA5 Regulation 5(c) Requirement The registered manager develops and agrees with each service user and or their representative, a written and costed contract/statement of terms and conditions between the home and the service user. This requirement was not completed following the previous inspection. The registered person shall, having regard to the size of the care home, the statement of purpose and the needs of the service users, ensure that at all times suitably qualified, competent and experienced staff are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that, the assessment of service users needs must be kept under review. Their needs during the night must be fully assessed and the sleep in provision reviewed based on the assessment. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 25 Timescale for action 31/08/06 2. YA33 YA2 YA18 18(1)(a) 14(2) 01/08/06 3. YA6 15(1) The registered person shall ensure each service user has a written plan as to how the service user’s needs in respect of his health and welfare are to be met. In that, the new individual plans must be fully completed as a matter of priority. 01/08/06 4. YA16 YA28 12(4a) The registered person shall make 31/08/06 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. In that, service users must be able to access the garden without going through another service users bedroom. Action plan to be provided by the timescale date specified. 5. YA20 13(2) The registered person shall make 01/08/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that, the protocol for administering rectal diazepam must state when during the seizure it is to be given. Medications that are prescribed as PRN but are used daily must be reviewed with the GP. 6. YA27 23(2n) Suitable adaptations are made, 31/08/06 and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled. DS0000064404.V298854.R01.S.doc Version 5.2 Page 26 151 Tunbury Avenue In that, the bathroom facilities must be made accessible to all service users and be fitted with the equipment identified as needed to meet service users needs. Action plan to be received by the date specified. 7. YA27 YA42 13(3) The registered person shall make 01/08/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. In that, the Manager must ensure that the redundant shower does not present a risk of infection. 8. YA27 YA23 YA42 13(7) The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. In that, the makeshift restraint on the toilet must be removed. The risks to service users in using the toilet must be assessed by an appropriately qualified person and any safety restraint used must be approved and professionally fitted. 9. YA29 23(2n) Suitable adaptations are made, 31/08/06 and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled. 13/07/06 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 27 In that, appropriate scales must be available for service users. This relates particularly to the service user who requires his pressure mattress to be set by weight. 10. YA30 13(3) The registered person shall make 31/08/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. In that, laundry must not be carried through the kitchen. Laundry equipment should be located away from food preparation and storage areas. Action plan must be received by the date specified. 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. Refer to Standard YA6 YA7 YA17 Good Practice Recommendations It is recommended that service users be encouraged to be involved in the development of their individual plan and to sign the plan. It is recommended that alternatives ways to support service users without verbal communication to make decisions are sought. It is recommended that an assessment of service users nutritional need be carried out to ensure the menu meets their needs. It is recommended that the Manager undertake training in nutrition to help him to plan menus and to monitor the nutritional intake of service users. It is recommended that the complaints procedure be displayed in the home in a user-friendly format for service users and their relatives. It is recommended that the plants and the shrubs in the garden be maintained to make the garden a pleasant environment for service users to use. DS0000064404.V298854.R01.S.doc Version 5.2 Page 28 4. 5. YA22 YA28 151 Tunbury Avenue 6. YA29 7. 8. YA37 YA39 It is recommended that when the kitchen is reviewed consideration be given to service users that use wheelchairs. For example, service users would benefit from lowered worktops and accessible appliances. It is recommended that the Manager complete the NVQ4 in management and in care. It is recommended that a formal quality assurance policy be developed for the home. 151 Tunbury Avenue DS0000064404.V298854.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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