Inspection on 13/05/08 for 20 Allington Way

This inspection was carried out on 13th May 2008.

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

Other inspections for this house

20 Allington Way 20/12/06

20 Allington Way 31/10/05

20 Allington Way 14/04/05

20 Allington Way 07/10/04

20 Allington Way 04/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 20 Allington Way 20 Allington Way Maidstone Kent ME16 0HJ Lead Inspector Jenny McGookin Unannounced Inspection 13th May 2008 09:45 20 Allington Way DS0000029146.V363484.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 20 Allington Way DS0000029146.V363484.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. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 20 Allington Way Address 20 Allington Way Maidstone Kent ME16 0HJ 01622 686681 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) allingtonway@mcch.org.uk www.mcch.co.uk MCCH Society Ltd Manager post vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2006 Brief Description of the Service: 20 Allington Way is one of a number of registered care homes managed by MCCH Society Ltd in the South East of England. The home offers 24-hour care for 3 adults from 18-65 years of age who have a learning disability. The home has one member of staff sleeping in at night. The accommodation has a large kitchen / dining area, single bedroom, bathroom with WC and lounge on the ground floor. There are two further single bedrooms, bathroom with WC and staff sleepover / office on the first floor. The home has a large rear garden and ample off street parking for three cars. There is also un-restricted street parking. Service Users are encouraged to take part in daily activities within the home and community and to access the local amenities. The home is situated near the main A20, with easy access to regular public transport into Maidstone town centre. The town centre is approximately 2.5 miles away. There is also a small row of local shops and amenities accessible in Allington. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. The range of fees was not available at the time of this inspection. Fees do not cover personal items such as toiletries, clothes, magazines, leisure and social activities (though the fee does cover some staffing costs), extra furniture and fittings, the service users’ own possessions or holiday costs. The e-mail address for this home is: allingtonway@mcch.org.uk 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection site visit, arranged at 24 hours notice, which was intended to inform this year’s key inspection process; to review findings on the last inspection (December 2006) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion, given all the timeframes set had run their course. Special attention was given to this home’s arrangements for safeguarding its service users. Our findings will be used as part of a wider investigation that we are doing, about the quality of care that people with learning disabilities. This report will be published in 2008. Further information on this, and thematic inspections can be found on our website www.csci.org.uk. The inspection process took eight and a half hours, and involved meeting with the manager, a senior support worker, MCCH’s own House Finance officer and all three service users. Consideration was also given to the Annual Quality Assurance Assessment submitted by the manager. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The visit also involved an inspection of two bedrooms and the communal areas, and the examination of a range of records. One service user’s files were selected for case tracking. Conversations with the service users were limited in most cases by their level of disability, but interactions between staff and the service users were observed during the day. Feedback questionnaires were issued by the inspector for distribution to service users and a range of other stakeholders, but not in time to include all the responses in the first draft. Any responses received after the final publication of this report will, therefore, be assimilated into the Commission’s own intelligence, for future reference. What the service does well: What has improved since the last inspection? 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 6 The home’s AQAA reports that the Statement of Purpose and Service User Guide have been updated and made more accessible, and improvements have been made to care plans and other documentation (most notably in respect of healthcare and risk assessment). One service user has been successfully encouraged to access community resources such as restaurants, cafes and shops. The AQAA also told us that there have been some improvements to the building. The lounge and dining room/kitchen area have been redecorated, and a patch of hard surface has been pressure cleaned to make its use as a patio area safer. 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. The summary of this inspection report can be made available in other formats on request. 20 Allington Way DS0000029146.V363484.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 20 Allington Way DS0000029146.V363484.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 3, 5 This home needs to evidence that prospective residents and their representatives benefit by having all the information they need to decide whether this home will meet their needs. Each placement is subject to contracts, which define the service the prospective resident will receive, but these need to be clearer and more accessible, if service users are to benefit from them. EVIDENCE: The last inspection (December 2006) established that this home has a Statement of Purpose and Service User Guide, as required, but both were at that stage under revision, with a view to making them more accessible to the service users. Although this work was reported to have been carried out, revised copies were not submitted for assessment against the provisions of the National Minimum Standards as requested, in time for this report. And they were not on the file selected for case tracking. So we were unable to reach a finding. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 9 The last inspection also found that the latest admission had been properly introduced and supported to settle. There have been no further admissions since then and none are planned. So this element of the National Minimum Standards was not inspected on this occasion, other than to establish that the existing residents were content with their placement. The placement of each of the three current residents is funded by Kent County Council, which has its own contractual arrangements, which are outside the scope of this inspection. But the file selected for case tracking had three other contractual documents in place. There was a tenancy agreement between the landlord (for whom MCCH acts as its agent), a support contract, which is intended to be read in conjunction with the tenancy agreement, and a much older variation to the tenancy terms and conditions. None of these documents was in an accessible format - the tenancy agreement, in particular, was written in very legalistic terms. And none had been signed or dated by the service user or their representative. The support contract had not been updated to take into account all the provisions of the National Minimum Standards in respect of facilities (e.g. wash hand basins and a second comfortable chair in bedrooms – the reader is advised that non provision would need to be justified by documented risk assessment or “opt out” consultation). And it was difficult to see whether the older variation document (dated 1967) would have any bearing now. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 Individuals benefit by being involved in decisions about the care and support they receive. EVIDENCE: Each resident has four files, two of which are devoted to their care planning. We chose one service user to case track, which represented the latest admission, and spot-checked the other two to clarify our findings. The care plan files properly detail the service users’ health and personal care needs as well as their preferences. And they are underpinned by daily reports, instructions for staff and risk assessments, to keep people safe. A number of these documents are written in the first person to keep the service user’s perspective central, though it was not always clear whether they were written as a direct result of consultation or interpretation. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 11 There was evidence of reviews, though the file we selected for case tracking showed no change to the home’s original assessment of the service user’s “Strengths and Needs”. This was judged surprising, given the adjustments and skills development the service user would have undertaken since her admission. The latest annual review, moreover, did not identify those who had been invited or those who attended, so we were not able to judge how inclusive it was, most notably in respect of the service user under examination herself. See also sections on “Lifestyle” and “Personal and Healthcare Support” for more detailed findings. Observed interactions appeared appropriately familiar and respectful. Service users are supported to make choices (e.g. meals, activities and outings) and to carry out modest tasks. When one service user finished her meal, for example, we saw that she was able to follow simple instructions from the member of staff about clearing her place on the table and getting a drink for herself, smiling shyly as she did so. This indicated she was pleased with her achievement. Another service user was given prompts, which enabled her to put her shoes on for herself safely, to make sure that she did not hurt herself. We judged that some personnel records could be more systematically arranged, and that other records (staff recruitment) needed to comply with MCCH policy by being retained at head office, given its separate arrangement with the CSCI for inspection. But we were, otherwise, generally satisfied with this home’s arrangements for securing confidential information. The home has an office, which is kept locked when not in use, lockable office furniture, and its computer is password-protected. See section on “Environment” for findings in respect of lockable facilities. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 11, 12, 13, 14, 15, 17 People who use services benefit by the support they have to make choices about their life style. And they are also supported to develop their life skills. EVIDENCE: The service users at this home all show some understanding of the spoken word but two have very limited communication skills. Staff interpret their responses and behaviours accordingly. Our case tracking indicated they have access to a range of activities, tailored to the individuals’ level of interest, on and off site. The home is reliant on MCCH, day services and families for much of this. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 13 Employment may not currently be realistic prospects for these service users, given their level of learning disability, but work experience opportunities have been accessed by one service user, to good effect. One attends two separate day services for therapeutic sessions (sensory, Keep Fit, swimming and arts and crafts) as well as some skills development (computer, cooking). The manager told us he routinely discusses the service users’ activities with day services staff, and that the day services are represented at care planning reviews, to ensure a rounded approach. But review documentation did not properly evidence how developmental work done in day services or the home was being followed through by the other. Activities organised by the home include games such as snakes and ladders, or Bingo. And staff offer direct support in some light practical daily living skills (e.g. tidying, collecting laundry or crockery, shopping). One service user likes to pour over catalogues (we observed her doing so and photos and the home has its own stock of music, videos and DVDs. Service users also join service users in other MCCH services for social events. The home has access to its own vehicle but this is subject to the availability of staff authorised as drivers. This matter was raised by the last inspection, without any further progress, so that service users are effectively being financially disadvantaged in having to fund taxis. The home is within reasonable access to some community resources and events that implies i.e. there is some scope for activities not restricted to the service users’ disabilities. The service users go out for meals, some community events and drives. We were told about the progress being made with one service user who had previously been reluctant to go out at all. There are open visiting arrangements. The home has three phones throughout the property. None of them are pay phones and no charge would be made for their use, but the service users make little or no use of them. Two service users have regular direct contact with their families and one only takes incoming calls. Each individual’s nutritional needs and preferences are properly established as part of the care planning processes and carefully monitored and amended on a day-to-day basis thereon. Staff eat with the service users and are able to eat the same food, subject to a voluntary contribution towards the cost. This is judged a good quality assurance tool. During the site visit, we joined two service users (while the third was off site), the manager and one member of staff for lunch. Each service user had something different and we judged the meal well prepared and presented. The pace of the meal was unhurried and the atmosphere was relaxed and congenial. One service user who was unable to verbalise, became restless at one point when her food slipped off her plate and stained the place mat. The 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 14 member of staff realised how important it was to her to have things in good order and discreetly tidied up, so she was able to continue eating. See section on “Environment” for findings in respect of the dining facilities. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 18, 19, 20 The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The care planning processes properly assess the extent to which each service user requires assistance with their own personal and health care, and their choice and control is actively promoted by staff as far as possible. All three service users’ bedrooms are single occupancy and there are enough toilet and personal care facilities to guarantee their availability and privacy. Staff are available on a 24-hour basis to assist service users. MCCH has a comprehensive range of policies for most aspects of its operation, though we noted from the home’s AQAA that it did not have one available on 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 16 site for continence promotion. This was judged surprising as continence is being managed at this home. The care planning process routinely addresses a range of standard healthcare needs (e.g. the home uses several GPs in one practice, as well as chiropodists, dentists, optician and physiotherapist). We understand a reflexologist also visits the home. One service user with complex health needs is supported with regular hospital attendance for dialysis and other health appointments. She told us how much she enjoyed the dialysis process and the hospital environment. The medication arrangements were assessed against the National Minimum Standards and found to be compliant. The home has a medication cabinet, which is kept locked when not in use and which is properly secured to a wall. And the home’s arrangements are designed to keep people safe. The home uses the Monitored Dosage System (MDS), which is colour coded according to whether medication is to be administered in the morning, afternoon or in day services (which, in turn, also use a separate code). Each service user also has a readily identifiable bag for any medication taken on outings. Medication, which can’t be blister-packed, is kept in its original labeled boxes on separate shelves (one for each service user), and there are separate administration sheets for non-MDS medication. There were no apparent gaps or anomalies in the records seen, and there have been no medication errors reported to the Commission since the last inspection (December 2006). All staff are trained to administer medication, though there needed to be a list of signatures to enable the tracking of any errors or omissions, should they occur. The home had recently acquired the latest copy of the Royal Pharmaceutical Society Guidance, for reference, though its copy of the British National Formulary (directory of medication) was very out of date (2004) and will need updating, to properly underpin current knowledge and practice, though staff can access this information on the Internet. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 22, 23 People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: As reported earlier, revised copies of the home’s Statement of Purpose and Service User Guide were not submitted for assessment against the provisions of the National Minimum Standards as requested, in time for this report. And they were not on the file selected for case tracking. So we were unable to reach a finding in respect of whether they gave clear information about how to use the home’s complaints procedure or how to contact people they know in the social or healthcare offices, who could represent them. But we felt the manager and the member of staff we met on this visit had a good understanding of people’s individual needs and how to meet them. The manager helped us put questions to one service user about how she had expressed her unhappiness in the past and how this had been resolved. We felt this could usefully have been pursued through the home’s complaints procedure. The service user told us several times how happy she was now and who she would tell if she wasn’t. The home’s AQAA told us that MCCH has a policy, which specifically addresses core values such as privacy, dignity, choice, fulfilment, rights and 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 18 independence. But MCCH also has a wide range of other policies designed to apply these core values to practice, both on a day-to-day basis and in response to extraordinary events such as outbursts from service users or poor practice by staff, should these occur. MCCH also has a checklist in front of each policy, which is designed for staff to certify having read and agreed to comply with their provisions. Unfortunately, a number of staff hadn’t done so. We were shown the home’s copy of Kent County Council’s multi-agency protocol, and saw cross-references to other funding authority protocols – all of which is designed to obtain a timely and co-ordinated response to any incidence of abuse, should it occur. However, there was no evidence (e.g. checklist) to certify that staff had read and agreed to comply with their provisions. This was recommended. All staff have had safeguarding training, and the member of staff on duty was able to tell us how staff had used this training, to bring MCCH’s attention to poor practice in the past, to put things right for the people who use the service. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 24, 25, 26, 27, 28, 29, 30 Some matters have been raised for attention year on year, but the physical design and layout of the home generally enable services to live in safety, and encourages their independence. The property is adequately maintained and comfortable. EVIDENCE: The home’s location (in terms of access to community resources) and layout are generally suitable for its registered purpose, and measures are in place to keep the premises secure against unauthorised access. We judged the paintwork on the front aspect of the building would benefit by being refreshed. All areas of the home were inspected and found to be homely, comfortable and appeared clean. Comfortable lighting levels and temperatures were being maintained. But we were concerned to find a number of radiators did not 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 20 have guards (matter raised by the previous inspection), because of constrictions of space. Low-surface-temperature models should, therefore, be considered. The furniture tends to be domestic in style and there were homely touches throughout. The home has a no-smoking policy. The rear garden is an enclosed oblong shape, without any features or positive focal points, other than a few shrubs down one side. We were told that MCCH had cut back the number of hours their gardener could provide, with the result that the grass had overgrown, concealing uneven surfaces, which we judged potentially hazardous. A link-wire fence down the opposite side was clearly buckled and damaged, and will require making good or replacement. There is a patio area, which is shaded by the L shape of the building. The seating in the dining and lounge areas is uniform in style, but this is judged appropriate for the service users, accepting one tends to stay in her wheelchair. In this home, the kitchen, dining room and washing machine are all in the same area. The arrangement is, overall, far from ideal. Although MCCH has taken the view that this is often how most domestic homes are set up, we do not think this is not good health and safety practice. It means that people are eating meals within reach of equipment, which could be sharp or dangerous because it has been heated up. If one service user becomes upset and restless over mealtimes and lashes out, this could put them or others at risk. Given the level of incontinence, moreover, an earlier decision by MCCH to site the home’s washing machine in the kitchen / dining area was never compliant with health and safety standards; and its recent replacement with yet another domestic model without a sluice facility was judged poor practice. The external windows and door of the kitchen, moreover, do not have fly screens, nor is there an insectocutor, to prevent the infestation of flying insects. And staff who are responsible for catering, are also required to use communal WC facilities. The COSHH cupboard is also located in the kitchen but it is being kept securely locked when not in use. All three bedrooms are single occupancy. Two bedrooms were inspected on this occasion and judged well maintained and personalised. In terms of their furniture and fittings, they were, however, not fully compliant with all the provisions of the National Minimum Standards. The reader is advised that non-provision needs to be justified in each case (e.g. by documented risk assessment or “opt out” consultation) – we did not find evidence of this in the file selected for case tracking. Despite the manager’s attempt to lower one service user’s bed, it was judged still too high for the service user’s comfortable use. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 21 One sliding ground floor bedroom door had a simple cabin-style hook and eye fastener as its only locking device, which would have to be forced to obtain access in an emergency. Each service user has a lockable cash tin, but these were not secured against a hard surface as a precaution against the risk of loss or theft. Service users have a choice of bath, shower and WC facilities. One bathroom requires attention because we saw a sizeable gap in the impervious flooring where a smaller bath had been installed, and the exposed area had not been sealed. We were concerned to discover a significant crack in the surface of a bath seat/hoist, which had simply been taped over to prevent it scratching skin. We were also concerned to find that none of the bedrooms has a wash hand basin (matter raised by the last two inspections). Some equipment is available to assist service users who require it for either personal or communal use. But there are no ramps inside the property and there is no shaft or chair lift, so the one service user, who is wheelchair bound, is restricted to the ground floor. See also above in respect of uneven garden surface. The lack of progress on matters raised for attention at the last inspection have combined with our other findings to start testing whether the “adequate” quality rating given for this section should continue to stand. The current arrangements are not judged to be in the best interests of the service users’ health or safety. 20 Allington Way DS0000029146.V363484.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 32, 33, 35, 36 Staff in the home are trained, skilled and in generally sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The current manager is supported by a senior support worker as well as a team of support workers. Although some staffing hours remain unfilled (matter reported on at the last inspection), existing staff continue to cover most gaps, or MCCH’s own bank staff are used. The manager told us that every effort is made to ensure any bank staff used are familiar with the home, to ensure continuity of care. The following staffing arrangements apply. The working / waking day has been interpreted as 6.30am (e.g. to meet day service commitments) till 10.00pm, and staffing levels are applied flexibly by a range of shift patterns within that timeframe to support service users with needs and activities. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 23 That effectively means one should expect to find at least one member of staff on duty at all times, and two during more active times e.g. 8am till 4pm, 5pm or even 7pm. At nights there is one member of staff on sleeping duty from 10pm till 6.30am, and MCCH has on-call arrangements, for advice and in the event of emergencies. There are no ancillary staff. Support workers are responsible for cooking, laundry and cleaning the home, and support the service users with light domestic duties. They are to be commended on the level of cleanliness found. The manager has taken the view that the overall staffing establishment is adequate. But we saw that these service users would require 1:1 support at times, within the home and to go out. So it is difficult to see how this can reliably be achieved on a day-to-day basis. None of the current service users attends any evening clubs, events or activities, though the manager was confident his budgets allowed some further flexibility to offer staff support, should this apply. The manager told us that recruitment is managed by MCCH’s Human Resources department, which keeps the documentation at head office, and simply notifies unit managers when checks have been satisfactorily completed and of each individual’s start date. The manager said he understood MCCH routinely carries out POVA 1st checks, CRB checks, and that it normally requires two references – though one member of staff was subject to 4-5 references because she had worked for a range of agencies and came from overseas. These records are subject to a separate inspection at MCCH’s head office by one of CSCI’s own managers at least once a year – though we did find several recruitment documents on site. We noted from the home’s AQAA that it did not have a policy for staff induction and foundation training on site. This was judged surprising even if this is being managed by head office, as all parties should be kept apprised. Records confirmed that staff had documented supervision sessions, though the frequency of these was variable (between 2-5 weekly). The records did evidence that work with individual service users was being monitored; and the sessions were being used to identify training and development needs. This arrangement should ensure practice conforms to expected standards and does not become variable. The home’s AQAA told us that five of the home’s six staff have obtained NVQ level 2 or above, with more in prospect. Records indicate a sound level of training investment by MCCH in all the mandatory areas, to keep people safe, and we were told that training is supported with handouts to maintain their currency. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 24 20 Allington Way DS0000029146.V363484.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 37, 38, 39, 40, 41, 42, 43 The management and administration of the home is based on openness and respect. But the home cannot evidence that it has effective quality assurance systems. MCCH’s business management systems are not judged sufficiently effective. MCCH has not demonstrated a sustained awareness of its responsibilities regarding Standards, Regulations and Requirements. EVIDENCE: The current manager has been in post since February 2006, but has yet to submit an application for registration by the CSCI. This matter was raised at the last two inspections, and must be addressed as a priority. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 26 Records indicate that the last quality assurance feedback exercise carried out by the home was in June 2006 and only generated responses from 3 relatives. There was no documented evidence of this being repeated or extended to other interested parties (matter raised for attention by the last key inspection). The manager told us that feedback is generally sought informally through residents’ meetings, where they are asked if they are happy. While we had no reason to doubt that the service users have confidence in the manager, it was equally clear that they looked for cues from the manager and staff in all the responses we witnessed. Independent verification is recommended. The manager told us that although MCCH has a business development plan, this home does not have its own. So there is no way to track whether corporate objectives set by MCCH generally are being translated into local practice. Nor is there any evidence that feedback can influence the way services are delivered. Records show that Regulation 26 reports properly account for the first three months of 2008. But there was no report on file for April 2008 and the only report on file for 2007 was dated October. This report refers, in turn, to a previous report in April 2007 but this was not on file, and the last report before then was dated May 2006. This effectively means the registered person is not properly evidencing that checks are being made, to keep people safe. When asked, the manager himself had (with the exception of annual appraisals and one recent supervision session) not been having supervision from his line manager for over a year. One service user has a Court of Protection arrangement but their placements are all funded through care management arrangements with Kent County Council. Fees are managed at head office, but the home keeps records of individual service user’s personal allowances and day-to-day financial transactions. We met with MCCH’s own House Finance officer, who last visited this home in April and we were shown how transactions are properly underpinned with receipts, logged on a register and counter-signed, to keep them properly accountable. See section on “Environment” for findings in respect of lockable facilities. We observed one of the home’s daily cash float checks (the home runs several in parallel), and were told that the service users were usually present, though their level of understanding was very limited. There was, overall, a minor shortfall of only a few pence against the account of sums held. The home’s AQAA told us that MCCH has a comprehensive range of policies for most aspects of its operation, and these are kept updated. On this site visit we looked at those, which have been designed to safeguard its service users. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 27 These policies usefully cross-refer to each other, to ensure a rounded approach, and there is a checklist in front of every policy, which is designed for staff to certify having read and agreed to comply with their provisions. Unfortunately, a number of staff hadn’t done so. So we could not be confident that staff practice would not in the event become variable. The lack of progress on matters raised for attention at the last inspection have combined with our other findings to cause us to reconsider the “good” quality rating previously given for this section. We feel we have cause to question whether even an “adequate” quality rating for this section should stand. The current arrangements are not judged to be in the best interests of the service. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 28 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 X 2 X 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 1 2 2 2 2 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation Requirement Timescale for action 30/06/08 4(2)5(1)(2) The statement of purpose and service users guide need to be made available in formats accessible to service users. The registered person shall supply a copy of each document to the Commission, for assessment against the provisions of the National Minimum Standards. 2 YA5 5 (c) The contract needs to be made available in formats accessible to service users. The registered person shall supply a copy of this document to the Commission, for assessment against the provisions of the National Minimum Standards. 30/06/08 3 YA30 13(3) The registered person shall make more suitable arrangements to prevent infection, toxic conditions and spread of infection at the care home. 31/07/08 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 30 This is to be interpreted in terms of the provision of a washing machine with a sluice cycle and its re-siting away from food preparation and dining facilities, to reduce risk of cross infection. This requirement is repeated from the last inspection – original timeframe 28/02/07 Action plan to be submitted 4 YA30 13(3) A wash-hand basin needs to be fitted in each service users bedroom. The requirement for the fitting of washbasins is repeated from the last two inspections – previous timeframe 28/02/07. 5 YA37 9(2) Action plan to be submitted The manager of the home must apply to the commission for registration. This requirement is repeated from the last two inspections. Last timeframe - 30/01/07 6 YA42 13(4(a) Action plan to be submitted The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety In that radiator guards must be fitted or low-surface temperature models installed. 7 YA43 26 Action plan to be submitted Visits by registered provider. The registered person shall ensure that there is full compliance with the provisions DS0000029146.V363484.R01.S.doc 31/07/08 31/07/08 31/07/08 30/06/08 20 Allington Way Version 5.2 Page 31 of this regulation. Breach is an offence. 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 YA11 YA20 Good Practice Recommendations Care Plans and their reviews should list those invited to participate and evidence the contributions of all participants, most notably the service users. Care planning documentations should evidence the work done by the home and other sources (e.g. day services) in the development of skills and opportunities Medication arrangements. The following matters are raised for attention. • The question of allergies should be more routinely recorded on each MAR chart. • The home’s copy of The British National Formulary was in need of updating. Building. The following recommendations are made: • The kitchen windows and door should have fly screens, to prevent the infestation of flying insects, or an insectocutor installed • Portable lockable facilities should be secured against a hard surface as a precaution against their loss of theft. • The rear garden should be landscaped to provide attractive focal points, and maintained thereon • Uneven surfaces should be levelled as a precaution against the risk of accidents • A link-wire fence along one boundary requires repair pr replacement It is recommended that the home consider increasing the number of staff that can drive, so that no service user is financially disadvantaged by having to fund taxis. All staff (including the manager) should have regular supervision from their line manager, to ensure compliance with the provisions of this standard. It is recommended that quality assurance surveys be sent to all interested parties i.e. professionals involved with service users as well as to relatives. The manager should ensure that staff have read and agreed to comply with the provisions of MCCH policies and DS0000029146.V363484.R01.S.doc Version 5.2 Page 32 4 YA24 5 6 7 8 YA13 YA36 YA39 YA40 20 Allington Way 9 YA41 10 YA43 procedures, so that practice does not become variable. Records. The following recommendations are made in respect of personnel records: • That there should be compliance with MCCH on which records should be retained on site and which should be managed by head office. • The contents of individual files should be systematically arranged and secured against loss or disarray The home should have its own business development plan. The views of all stakeholders will be crucial to the success of this. 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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. Extracts may not be used or reproduced without the express permission of CSCI 20 Allington Way DS0000029146.V363484.R01.S.doc Version 5.2 Page 34 - 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. 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