Inspection on 29/05/08 for 3 Lenham Road

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Lenham Road 31/10/06

3 Lenham Road 29/11/05

3 Lenham Road 04/07/05

3 Lenham Road 15/03/05

3 Lenham Road 10/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 3 Lenham Road 3 Lenham Road Headcorn Ashford Kent TN27 9TU Lead Inspector Jenny McGookin Unannounced Inspection 30th May 2008 09:30 3 Lenham Road DS0000024086.V363488.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 3 Lenham Road DS0000024086.V363488.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. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 Lenham Road Address 3 Lenham Road Headcorn Ashford Kent TN27 9TU 01622 891067 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) k.belcher@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 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2006 Brief Description of the Service: 3 Lenham Road is one of a group of small care homes managed by MCCH Society Ltd. The home provides care for three adults aged 18 -65 years with a Learning Disability. It is a 10-minute walk from Headcorn village centre and very close to a local shop. The accommodation is provided on two floors, with the three bedrooms occupied by service users on the first floor. All three bedrooms are single. The three service users share a first floor bathroom and toilet facilities. The staff sleep-in room is located on the ground floor adjacent to the entrance hall. The ground floor also has a toilet, an adapted shower facility, dining room, kitchen and lounge. The staff roster allows for one member of staff on a sleep in duty at night. The home has no staff employed to be responsible for catering and domestic duties, and the usual routine is for all staff and service users to undertake these duties. The cost of the service is £1,138.00 per week. Extra charges are payable for 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. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address for this home is: k.belcher@mcch.org.uk 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection site visit, which was intended to review findings on the last inspection (October 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. The inspection process took just over seven hours, and involved meetings with the manager and two support workers. Some interaction was possible with the service users, and interactions between staff and service users were observed. The inspection involved an assessment of the premises and a range of records. Two service users files were examined in detail along with all available personnel files. Consideration was also given to the Annual Quality Assurance Assessment (AQAA) submitted by the manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. Feedback questionnaires were issued by the inspector for distribution to service users and a range of other stakeholders, but not in most cases 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: The location of this home is generally suitable for its stated purpose, convenient for visitors and offers ready access to community resources. Property maintenance checks were in good order, and the home was tidy, clean and odour free when inspected. Service users needs are thoroughly assessed, monitored and reviewed. There are consistently positive outcomes for people using the services and key standards are met. The person-centred care plans are judged holistic and service users enjoy a variety of activities. The staff team is committed, well-trained and well deployed. This is a staff team, which feels well invested in, and supported on a day-to-day basis. 80 of the permanent staff have accreditation to NVQ2 or above. Team working and flexibility have been identified as key strengths of this staff team, and the 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 6 rapport between the manager, staff team and service users is appropriately familiar, relaxed and respectful. When asked what they felt the service does well, staff told us • “Ensures health issues are followed up. Ensures service users are safe and risk assessments are current. Service users are well cared for and family members are encouraged to be involved with appointments, visits etc”. “Provides well for the service user”. • Compliance was found with most aspects of the National Minimum Standards inspected. Record keeping is systematic and open to inspection. What has improved since the last inspection? What they could do better: MCCH has not demonstrated a sustained awareness of its responsibilities regarding Standards, Regulations and Requirements. MCCH’s failure to provide a registered manager is just one example, which will require addressing as a priority. MCCH needs to evidence a sustained compliance with its regulatory duty to carry out documented unannounced inspection visits at least once a month. The reader is advised that breach of this regulatory duty constitutes an offence. A statutory Enforcement Notice may become warranted. Feedback from staff has suggested there should be more activities around the home, such as domestic chores and in the kitchen. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 7 Work identified by MCCH’s own property inspection and this site visit requires attention. It is accepted that the redecoration of a bedroom and the lounge is planned in the next 12 months. Bedroom furniture should be assessed against the provisions of the National Minimum Standard. Non-provision should be justified in each case by properly documented risk assessments of consultation. Staff have told us they have had to lone work on occasion because of funding constraints. It is accepted that the home plans to recruit a full time member of staff to reduce the need for as many casual staff and to relieve the pressure on existing staff to provide cover. The home’s AQAA indicates a need to give staff training in communication. 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. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 8 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 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 9 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 good This judgement has been made using available evidence including a visit to this service. 1, 5 This home could better 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 and their representatives are to benefit from them. EVIDENCE: The last inspection (October 2006) established that this home has a Statement of Purpose and Service User Guide, as required, and this site visit was used to assess one version of the Service User Guide. A number of recommendations were made to further improve this document, and to evidence their issue to service users and their representatives, and these were reported back to the manager separately. There have been no admissions since November 2005 and none are planned. The last inspection also found that the latest admissions had been properly introduced and supported to settle. So this element of the National Minimum 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 10 Standards was not inspected on this occasion, other than to establish that the existing residents were content with their placement. In common with other homes in the MCCH group, we understand that 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. And each placement is also subject to other contractual documents in place, representing a tenancy agreement between the landlord (for whom MCCH acts as its agent), and the support MCCH undertakes to provide as well as spot contracts used to top up all of the above. These have yet to be rationalised into one document, to clarify the arrangements. None of these is reported to be in an accessible format, which could be meaningful to the service users. 3 Lenham Road DS0000024086.V363488.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 6, 7, 8, 9, 10 Individuals benefit by being involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The format of this home’s care planning processes should enable all aspects of each service user’s personal and health care, as well as their social care needs to be addressed. There is, in each case, useful background information, as well as “strengths and needs” assessments, goal setting and staff guidance, to ensure care is delivered appropriately. This is all properly underpinned by daily reports and risk assessments - generalised and individualised (i.e. which look at each individual, their activities and the settings on and off site) to ensure people stay safe. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 12 And care-planning documentation is presented in an accessible format, and written in the 1st person to ensure the service user’s perspective stays central to the process. The home’s AQAA told us that facilitators had been introduced to ensure the care plans are person-centred, and the plan is to continue to use person–centred planning, advocacy and regular meetings to pursue identified goals. Care plans are subject to regular checks by a senior support worker, and are reviewed every six months (unless earlier reviews are warranted) in meetings led by the home, as well as annually by the funding authority. Annual reviews properly identify who participates so that we were able to judge how inclusive they are. There are opportunities for service users to participate in the decisions such as menu planning and activities, both individually and in group “house meetings”. Observed interactions were judged appropriately familiar and respectful. We were satisfied with the home’s arrangements for securing medication, valuables and confidential information. Facilities are lockable and the home’s computer is password-protected. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 13 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, 16, 17 Service users benefit by the support they receive to make choices about their life style, and to develop their life skills. Social, educational, cultural and recreational activities meet individual’s assessed needs and expectations. Service users benefit by the provision of a nutritious and varied diet. EVIDENCE: Abilities, activities and personal preferences are properly identified in care plans and promoted by weekly planners, day-to-day consultation, and by what’s known as SUMOs i.e. “Service Users’ Meetings Out”. We were told that the next one would be at the Rare Breeds centre. In winter months these can take the form of themed discos. One service user, with on-set dementia has 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 14 been a challenge to keep motivated but the other two access a range of activities, including mainstream community activities not readily associated with or restricted to people with disabilities. On site there are opportunities to do painting, drawing, sewing and to play ball games. The planners also include support with domestic tasks as well as free time. As reported at the last inspection, service users are supported with their own finances, and budgeting is part of their weekly routines. The local village has a selection of shops, pubs and tearoom facilities, and the service users walk up there most days. One service user used to do a lot of walking, but would need more staff support to do so now. Two of the service users attend MCCH’s own Club Connect in Maidstone twice a week. They go there for handy-crafts, Cook-and-Eat sessions, days out to the seaside, zoo etc. We were told how two people come in to Club Connect to enact things like the Wizard of Oz, and how they bring props with them. They also tend to spend Friday evenings out at the local Gateway Club. None attends day services. Other activities off site include bowling, cook-and-eat sessions on Thursdays, and Salvation Army meetings. Two were in fact attending a Salvation Army meeting on the afternoon of our visit. We were told that someone from the Donkey Sanctuary would be attending and that they would sing songs and have prayers. Each session lasts for an hour, and are popular. Church is also important to these service users. Two have been going back to their Baptist Church in Maidstone, where they had lived previously, once a month. One also attends a local Methodist church. Employment may not currently be realistic prospects for these service users, but work experience opportunities have been accessed. One did try sorting MCCH internal post. We were told that initially she had enjoyed it, then decided not to go anymore. She had also tried Tuck n’Truck but her dementia deteriorated quite a lot. Staff had taken her to “Growing Concern” where she could do some gardening, but she didn’t like that either. Staff have been trying to find things to interest her. One used to work in a local charity shop but is not able to now. There are open visiting arrangements, and service users are properly supported to maintain contact with their relatives. Contact is documented, as is their participation in care planning processes. The home has one wallmounted pay phone box at the front end of its entrance hall. There is also a mobile handset, which the service users could use. Each individual’s nutritional needs and preferences are properly established as part of the care planning processes and carefully monitored and amended on a 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 15 day-to-day basis thereon. There was anecdotal information on how one service user’s weight gain is being monitored. In common with other homes in the MCCH group, 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. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 16 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 process assesses the extent to which each service user can manage their own personal care, and their choice and control is actively promoted by staff. Daily records are maintained. The bedrooms in this home are single occupancy, and their doors are lockable (snib operated on the inside and key operated from the outside). Two service users have been risk assessed as able to manage a door key. There are enough toilet and personal care facilities (baths, showers, wash hand basins) to enable the service users to exercise some choice, – and staff are 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 17 available on a 24 hour basis to assist them. Observed practice was judged appropriately familiar and respectful. The home’ s person-centred care planning process routinely addresses a wide range of healthcare needs e.g. GP, optician, audiologist, neurologist, speech and language therapist, psychiatrist and chiropodist, as appropriate. And each service user has their own Health Action Plan. The AQAA told us that in the last 12 months, a service user had been supported to register with a suitable dentist, after being reluctant to do so for some considerable time. There are GP reviews of medication every year, though we were told that individuals’ medication tends to stay the same, year on year. The home uses the monitored dosage system (MDS) and medication administration record (MAR) sheets. Recording standards were judged satisfactory, there were no apparent gaps or anomalies. Where medication is only required in certain circumstances, there were protocols in place, properly dated to evidence their currency. The manager showed us the home’s copy of the Royal Pharmaceutical Society Guidance, used to ensure its practice is compliant with best practice. Although the home’s copy of The British National Formulary (BNF) was dated 2000 (and therefore in need of updating) we were assured that staff can access BNF information on the Internet. The home also keep information leaflets issued with medication. The home keeps its medication properly secured in a lockable wall-mounted metal cabinet. Staff are subject to annual competency testing and MCCH gives formal training / updates on medication, to keep people safe. The home maintains a list of signatures of staff authorised to administer medication, so that any errors could be tracked, should they occur. Notwithstanding our findings, there have been no periodic inspections by a pharmacist – this is recommended, to ensure practice is compliant with emerging best practice standards. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 18 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 good This judgement has been made using available evidence including a visit to this service. 22, 23 People who use the service are supported to express their concerns on a dayto-day basis. There is a complaints procedure in place but it is not being used. Service users are generally well protected from abuse, and have their rights protected. EVIDENCE: The home has a complaints procedure, as required, and there is a pictorial version in each bedroom. However, the absence of registered complaints is not judged a realistic reflection of communal living. Previous feedback surveys completed by staff had told us that service users would be unable to complain or understand the procedure and rely on staff to recognise unhappiness. The challenge for this home will, therefore, be to interpret expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can properly judge compliance with this standard. There was no evidence of independent advocacy being used to support these service users, but the AQAA told us this is planned. Service users’ financial transactions are being carefully recorded, supported by receipts; and balance figures are in each case cross-checked by a second 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 19 member of staff, as evidence of probity. We observed one shift handover meeting where a check was made on one service user’s finances, as is the routine – the balance figure was found to match the sum in safekeeping accurately. We understand that MCCH has a finance officer who carries out unannounced checks (at least annually) of each home’s accounts, to keep arrangements safeguarded. MCCH has a wide range of policies designed to safeguard its service users, and records confirm that staff receive training as part of a rolling programme, to keep people safe. In discussions, staff confirmed their commitment to challenge and report any instances of adult abuse, though they each went on to say that this had not been warranted in this home. Our own records confirm that there have been no adult protection alerts in respect of this home since at least July 2005. 3 Lenham Road DS0000024086.V363488.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): 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 Service users with a reasonably safe, and comfortable environment – though matters are raised for attention in respect of its maintenance. The physical design and layout of the home encourages some freedom of movement and independence. 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. There are no ancillary staff in this home to do the cooking or cleaning. Support staff are responsible for this aspect of the home’s operation 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 21 and this includes supporting service users with light domestic chores of their own. The furniture tends to be domestic in style and there were homely touches throughout. Comfortable lighting levels were being maintained, but heating levels had been compromised by the disconnection of the gas supply to several properties for several days, while remedial work was being carried out. The home has a No Smoking policy. The seating in the dining and lounge areas is uniform in style, but this is judged appropriate for the service users, although an inspection recently carried out by MCCH has established that the lounge furniture is not fire retardant and will require replacement. The carpet in the dining area was stained in places. The home has a washing machine, but it does not have a sluice cycle (recommended practice). It is sited in a tiny laundry room separate from the kitchen, which means soiled washing does not have to be carried through an area where food is being prepared. However, the removal of a dryer from this room into an outside garage / store room means that staff are having to carry damp, albeit clean, laundry through the kitchen, and out across an unsheltered area to the garage / store. And work required to make the surfaces in the laundry room impermeable, easily cleaned and not open to infestation from outside (through a disused vent) is still outstanding. The arrangement is far from ideal. 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 located in the kitchen but it is being kept securely locked when not in use. The service users’ bedrooms are single occupancy. All three were inspected on this occasion and judged generally well maintained and personalised, accepting one is scheduled for redecoration – it had damage to one wall and doorframe. All bedroom doors are fitted with door guards, so that they can be left ajar if that is the service users’ preference, but will slam shut if the fire alarm is activated. In terms of their furniture and fittings, the bedrooms 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. The covering of one service user’s window panes with obscure sheeting will, in particular, need justification, as it is effectively preventing any outlook. Some lights did not work. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 22 Each service user has a lockable cupboard properly 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, and all three bedrooms have hand-wash basins. But the communal bath is reported to cause some difficulties for staff. And MCCH’s own recent inspection found that the shower room does not drain well – staff have to use a broom to sweep water away. And staff cannot reportedly use an extractor fan because neighbours can hear it at night. Both facilities had broken tiles, which will require attention or replacement by the property’s landlord. The property maintenance records seen were up to date, though the duration of one electrical installation check will require confirmation. But MCCH’s own recent inspection found that on emergency light did not work, despite a recent repair, so this will require attention, to keep people safe. See schedule of recommended action. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 23 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, 34, 35 Service users generally benefit by a staff team which has the training and skills to support them and to generally ensure the smooth running of the service. However, some recruitment checks require review, to ensure service users stay safe. EVIDENCE: The waking / working day has been interpreted as 9am till 10.30pm, and visitors could generally expect to find two support workers, including their line manager on duty (though she does occasionally work as the third person on site, to enable staff to support service users with outings). There are, however, times when we were told staff have been lone working because of funding constraints. At night there is invariably one member of staff, sleeping but on call. And there are wider on-call arrangements to keep people safe. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 24 There are no dedicated ancillary staff (e.g. cooks or cleaners). These tasks are covered by the staff who are also responsible for direct care. All three service users are supported to carry out some light domestic chores. Records indicate a sound level of training investment by MCCH in all the mandatory areas, to keep people safe. The range of mandatory training opportunities available includes food safety, fire safety, manual handling, First Aid, safeguarding adults, and medication administration – as well as some specialist input to meet the service users’ special needs. 80 of the permanent staff have accreditation to NVQ2 or above. Team working and flexibility have been identified as key strengths of this staff team, and the rapport between the manager, staff team and service users is appropriately familiar, relaxed and respectful. Both support staff spoken to on this occasion confirmed that they had formal documented supervision from their line manager, which in both cases exceeds the National Minimum Standards in terms of frequency, and the manager was said to be accessible and supportive. This arrangement should ensure practice conforms to expected standards and does not become variable. However, records indicated that this did not represent all staff, or practice up until recently. This will require sustained attention. We understand that that recruitment is managed centrally by MCCH’s Human Resources department, which keeps the documentation at head office. Unit managers are then notified, by way of a checklist, which checks have been satisfactorily completed and of each individual’s start date. MCCH routinely carries out POVA 1st checks, CRB checks, and it normally requires two references. 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 checklist documents on site, they did not account for all the checks we would expect to be carried out. So we were unable to reach a finding on recruitment. 3 Lenham Road DS0000024086.V363488.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, 42, Service users benefit from the management and administration of the home, which is based on openness and respect. But the home needs to better 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: This home has undergone several changes of management in a very short period of time. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 26 The current manager, Karen Belcher, has been in post since April 2007, having previously been the registered manager of another home in the group - but she has yet to submit an application for registration by the CSCI in respect of this home. She told us she has obtained accreditation to NVQ2, 3 and 4 levels. And she told us that last year she completed her Assessor’s award and was currently waiting for RMA training. Feedback from staff indicated that she is approachable and supportive, and observed interactions were relaxed and respectful. The records and documentation seen were in good order, up to date, systematically arranged and securely stored. There was good evidence of business planning at a corporate and unit level over the past year. MCCH had set six corporate objectives for 2007/8, which then generated objectives for its West Kent operation. Each unit was then tasked to come up with measurements and outcomes, lead officers and targets to meet those objectives. Lenham Road’s action plan was in place. And the manager had also completed a very detailed assessment of the service in September 2007, which made conspicuous references to the National Minimum Standards, and a judgement about the service’s level of compliance. This was judged very promising. The registered proprietors of care homes have a regulatory duty to carry out their own documented unannounced inspection visits at least once a month. The last inspection (October 2006) reported that, following a lapse, these visits had been re-instated. But we found that there had been a further extensive lapse before these visits were re-instated again in October 2007, and there had been two months not accounted for since then. This effectively means the registered person had not been properly evidencing that checks were being made, to keep people safe. Breach of this regulatory duty constitutes an offence. A statutory Enforcement Notice may, therefore, become warranted. Records indicate that the last quality assurance feedback exercise carried out by the home among the service users and staff was in December 2007, and this has been topped up by regular service users’ group meetings. There was, however, no documented evidence of feedback being sought from other interested parties. This is judged a very modest start. The lack of progress on the registration of the manager, given the several changes of manager already reported, has combined with our other findings in respect of monthly visits by the registered proprietor have given us cause to question whether the “good” quality rating previously given for this section, should still stand. The current arrangements are not judged to be in the best interests of the service if they cannot be robustly sustained. 3 Lenham Road DS0000024086.V363488.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 2 2 X 3 X 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 3 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 X 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 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 2 2 X X 3 X 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 YA30 Regulation 13(3) Timescale for action The registered person shall make 31/07/08 more suitable arrangements to prevent infection, toxic conditions and spread of infection at the care home. This is to be interpreted in terms of the provision of a washing machine with a sluice cycle. Action plan to be submitted 2 YA37 9(2) The manager of the home must apply to the commission for registration. 31/07/08 Requirement 3 YA43 26 Action plan to be submitted Visits by registered provider. 31/07/08 The registered person shall ensure that there is full compliance with the provisions of this regulation. Breach is an offence. 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 29 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 Refer to Standard YA1 Good Practice Recommendations It is recommended that the home have a checklist to evidence the issue of a Statement of Purpose, Service Use Guide and contract, and whether other languages or formats were warranted. MCCH’s own recent inspection found that on emergency light did not work, despite a recent repair, so this will require attention, to keep people safe. MCCH should provide an action plan to address all the matters raised for attention by its own property inspection 14/05/08. Building – communal areas. The following recommendations are made: • Dining Room – carpet stained in areas • Dining room requires redecorating • Lounge furniture requires replacement with fire retardant models • The provision of furniture and fittings in bedrooms should be checked against the National Minimum Standards and non-provision should be properly justified by documented risk assessment or “opt out” consultation. • The covering of one service user’s bedroom window panes with obscure sheeting will need justification, as it is effectively preventing any outlook. G/F WC / Shower Room • Shower does not drain well – staff use broom to sweep water away • Broken tile beside WC. Sharp edges to be made safe • Cannot use extractor fan because neighbours can hear it at night 1st Floor WC / Bathroom • Cracked tiles at end of bath (furthest from taps) need replacing Bathroom / shower floors should be coved along the edges Kitchen. The following recommendations are made: • Now that the dryer has been moved to the garage, staff need to carry clean but damp washing through kitchen • Catering staff need to use the G/F communal facility DS0000024086.V363488.R01.S.doc Version 5.2 Page 30 2 3 YA24 YA24 4 YA24 5 YA25 5 YA27 7 YA30 3 Lenham Road 8 YA30 9 10 YA36 YA39 The kitchen windows and door should have fly screens, to prevent the infestation of flying insects, or an insectocutor installed • Front aspects of kitchen drawers have been coming adrift and should be made good. • Kitchen requires redecorating Laundry facilities. • Tumble dryer vent should be removed / blocked off to reduce infestation • Walls need repainting • Cracks / dents e.g. around sockets to be made good (matter raised by the last inspection) 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. • 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 31 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 3 Lenham Road DS0000024086.V363488.R01.S.doc Version 5.2 Page 32 - 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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