Inspection on 23/05/07 for 306 Southend Road

This inspection was carried out on 23rd May 2007.

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

Other inspections for this house

306 Southend Road 24/01/06

306 Southend Road 14/09/05

306 Southend Road 07/03/05

306 Southend Road 12/10/04

306 Southend Road 19/03/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Pocklington House

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

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

CARE HOME ADULTS 18-65 Southend Road (306) 306 Southend Road Wickford Essex SS11 8QW Lead Inspector Ms Bernadette Little Unannounced Inspection 23rd May 2007 09:35 Southend Road (306) DS0000018121.V340005.R02.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 Southend Road (306) DS0000018121.V340005.R02.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. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southend Road (306) Address 306 Southend Road Wickford Essex SS11 8QW 01268 570702 F/P 01268 570702 michellejones@hamelintrust.org.uk 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) Hamelin Trust Manager post vacant Care Home 4 Category(ies) of Learning disability (4), Physical disability (4), registration, with number Sensory impairment (2) of places Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2006 Brief Description of the Service: 306 Southend Road is a modern purpose built bungalow providing care and accommodation for up to four people with profound physical, learning and sensory disabilities. The premises are owned by Mosaic Essex, but managed and run by Hamelin Trust. A web site is available for the organisation on www.hamelintrust.org.uk The home is located a short distance from Wickford. Local facilities are available in the village of Shotgate where the home is located. The town centres of Basildon and Southend are a short journey away. The home provides residential accommodation on one level and there is adequate space for wheelchair users. Specialist equipment and adaptations such as hoists and bathing aids have been incorporated into the design to enhance the facilities for residents. There is an enclosed garden with a small patio area to the rear of the property. Limited parking is provided to the front and side of the property. The home is located on public transport routes. The home has their own minibus to facilitate community access. A Statement of Purpose is available for the home. This was last reviewed in December 2005. The document now requires further review so that it reflects the current management at the home, and provides up to date information for interested parties. An updated Service Users Guide is now available. The fees were advised as being between £256.97 and £259.09 per night ( £1798.79 to £1813.63 per week). The fee includes an annual seven-day holiday. Additional fees were advised as being for personal toiletries, individual leisure items such as the theatre, and any cost over £2.50p when having a meal out. It was advised that that weekly fees are no longer charged for transport. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken over a seven hour period. All key standards were inspected and the homes progress against their previous requirements was assessed. At the time of this inspection there were four people living at 306 Southend Rd. None of the residents have verbal communication and so no comments are quoted in the body of the report. One resident was home all day because they were unwell and time was spent with the other three when they got home in the afternoon. Interactions and non-verbal communications were observed. Five staff, the acting manager and the chief executive of Hamelin Trust were spoken with as well as one visitor. Surveys requesting information about the service were sent to relatives of each of the residents. Two responses were received which were complimentary. Information was also sought from two social workers and a GP, but no responses were received. A tour the premises was undertaken and medication, records, policies and procedures were sampled. What the service does well: What has improved since the last inspection? A service user guide has been produced for prospective/residents, that offers a welcome and provides clear information about life at the home. The electrical safety inspection certificate was available and the registration certificate was displayed. New carpets had been fitted in some areas making a more pleasant environment for residents and staff. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 6 Some new support staff had been recruited, including night staff and this will reduce the number of shifts that the home will use agency staff, giving more continuity for residents. Staff had also had sensory training and had begun communication training to help them better support residents. 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. Southend Road (306) DS0000018121.V340005.R02.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 Southend Road (306) DS0000018121.V340005.R02.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): 1, 2 Quality in this outcome area is good. Users of the service can expect good information about the home to help them to make a decision about living there and a detailed assessment to make sure that their needs can be met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last inspection, a service user guide has been produced. This was written in plain language, in large print and contained useful basic information for current and prospective users of the home. The acting manager advised that she is awaiting support to be able to add pictorial input to the documents to make it more user-friendly. The contact information for the commission and any relevant funding authority should be included, with some clearer information on how residents’ dignity and privacy, or religious needs will actually be met in practice. The acting manager should now update the statement of purpose as identified in the body of the last inspection report. One resident had been formally admitted to the home since the last inspection, although the assessment process was taking place at that time. Preadmission assessment documentation was not available for inspection on request. It was noted at the last inspection however that detailed assessment and planning was in progress with the involvement of the resident’s family. Trial visits had taken place and the acting manager confirmed that this formed part of the contract with the funding authority. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. Not all residents had care plans that identified their specific needs with clear instructions for staff to ensure that safe, individualised care could be consistently provided. Residents are ‘listened to’ and encouraged to participate in everyday life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care management documentation was sampled/tracked for two residents. One care file had good detail in several areas to support staff to provide appropriate care. Files would benefit from being re-organised to remove duplication and provide clearer access to necessary information. The second care plan had very limited information, for example there was no care plan regarding continence, oral care, diabetes, daily bathing, specific behavioural issues and inadequate/limited information on other issues such as medication. Information on some of these needs was discovered by reading other documents, correspondence or in anecdotal information in discussions with staff. Clear risk assessments were not in place to support several of these Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 10 issues where this was indicated. There was no evidence of relative/ advocate involvement in this care plan. While staff were clearly observed to be caring towards residents and committed to good life outcomes for them, the lack of identified care needs supported by risk assessment, and specific directions on how to meet those needs was a concern, in ensuring that all needs were met, that they were met consistently and particularly where there is regular use of agency staff. Risk assessments were in place relating to epilepsy, exploitation and abuse (for example financial), safe environment, bathing and transport and road safety. It was noted positively that residents were encouraged to observe/ participate in household activities, such as preparation and cooking of meals etc, and a risk assessment was in place relating to this. Staff also spoke to residents about things that were generally happening to involve them. Residents at 306 Southend Road had no verbal communication and so had limited opportunity to express their choices. Some staff had worked with residents for a long time and responded to their non verbal communications, body language and behaviour. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. Residents at 306 Southend Road have good opportunity to participate in varied activities, including in the community, and relationships with families are well supported. Residents are offered a varied and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents at 306 Southend Rd had access to formal day-care services on various days each week. The acting manager advised that with the recent appointment of a driver and purchase of the new minibus, residents do participate as fully as possible in a range of activities. These are more effective on weekdays when some residents are at day centres but more difficult at times at weekends and evenings when there are four wheelchair users and three staff. One resident’s file sampled indicated recent opportunities to visit the ballet, a musical at the Cliffs Pavilion, and an afternoon tea at Hadleigh Castle. In addition, this file contained a weekly activity plan that included regular contact with family, and evening activities including going to the pub or the Wickford Exchange, use of the sensory room or watching a video. One resident has been Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 12 abroad on holiday with their family and all residents were going on holiday together shortly after this site visit. Staff were aware of respecting residents rights, including in relation to choice and dignity. A newer member of staff advised that while they cannot gain residents expressed preference on what to wear each day, they would respect the resident’s dignity by matching clothes properly, making sure they are appropriate to age and the weather and by asking themselves “would I like to wear this”? A sample three week menu was provided with the pre-inspection questionnaire. Staff advised that this is planned by one of the senior carers and includes the option of a cooked breakfast at weekends. While no choices were shown as offered on the menu staff, confirmed that it is worked around the known likes and dislikes of residents. The menu offered variety with some dishes recorded as being home-made. Ample food stocks were available. The home provides a packed lunch for one resident to take to their centre to meet a specific dietary need. Another resident is PEG fed and has Nutritionist input. Records indicate that four staff have had recent training on gastronomy feeds. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. Residents are supported by caring staff that are attentive to identified healthcare needs. Residents are not best protected by the management of medication and identification/safe management of some aspects of healthcare and associated risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to protect a resident’s privacy and dignity where personal care was being provided. Discussion indicated that residents were provided with required levels of support for their personal care needs. Training records provided and certificates seen on files sampled for newer staff demonstrated that ten of twenty staff had not had safer people handling training in the past year. Residents had individual slings for hoists etc., and staff confirmed that all residents had the necessary individually assessed equipment to meet their needs. Safe moving and handling information was not clearly indicated on a care plan sampled and there was no risk assessment regarding pressure area issues. Staff were vigilant in monitoring resident health and well-being as was seen during the inspection. GP input and Consultant advice was sought without Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 14 delay. Records sampled confirmed appointments at the hospital, surgical fittings, with the GP, and three of the four residents went to the dentist during the site visit. Staff also spoke to residents, and sat on the floor with a resident who was unwell, talking and giving eye contact, holding their hand and making sure they were comfortable with pillows and monitoring fluid intake etc,. While a care plan was not available identifying/managing diabetes, instructions were provided on the procedure for blood monitoring. A detailed protocol regarding epilepsy/rectal diazepam administration was maintained, as were bowel charts. The record of restrictions of residents’ rights demonstrated that a resident had bed rails fitted to their bed. The care management file had no mention of this, including no detailed risk assessment, no plan of care/review, and no safety monitoring/audit. Training records provided show that not all of the six staff identified in the PIQ as those deemed competent to administer medication had had updated training/assessment in the past year. Since the last inspection, individual medication cabinets have been installed for each resident. Despite the obvious warmth in the room, regular checks were not being maintained of the temperature. On checking it was noted to be 27°, which is not a safe temperature to store medication and advice on timely action was provided to the acting manager. Protocols were in place in relation to rectal diazepam but not for items such as Calpol or zinc oxide. A homely remedies policy has not been produced as advised at the last inspection. No agreement was available on the suitability of each of these homely remedies for individual residents from the GP. Stocks and dates were checked regularly. A ‘buddy book’ system was in place to record two signatures of permanent staff that checked the time, resident and amount of medication administered. Omissions were noted on the MAR sheets so there was no clarity as to whether the medications were actually administered to the resident. The code ‘O’ was used on several occasions, but no explanation was recorded on the back of the sheets to explain. A photograph was not available on all the residents’ medication administration records (MAR) to assist with identification. Hand transcribed medications had been added to the MAR with no signatures to ensure accuracy and accountability. It was noted positively that one medication had been removed from the cassette following the advice by telephone of the GP after a staff member noted a possible contra-indication affecting a resident who was very recently prescribed antibiotics. It was of concern that the resident had been prescribed and administered the antibiotics but no record of them had been entered into the MAR. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 15 While the observed care provided to residents was appropriate, the lack of an appropriate care plan identifying specific identified needs, the lack of risk assessments to protect residents and the poor practice noted regarding medication are a concern and do not clearly evidence that residents were receiving best quality care and healthcare outcomes. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 16 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): 22, 23. Quality in this outcome area is good. Representative of users of the service felt able to express their views. Residents were safeguarded by staff knowledge and training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new service user guide contained clear information to support residents to express any concerns and would be enhanced with the additional planned pictorial input. Comments from relatives indicated that they would feel able to raise concerns. The formal complaints procedure was not displayed. It was found in the statement of purpose, was detailed and had appropriate timescales. The home had not received any complaints since the last inspection. There was no system to log complaints and outcomes and no format to record them separately to ensure confidentiality. The pre-inspection questionnaire identified that no residents had been subject to restraint since the last inspection. A record was available of restrictions placed on service users, for example the use of a strap in the wheelchair to prevent the risk of injury from falls. Body map and accident records were also maintained to record any bruises, marks etc. Records provided indicated that of the 21 staff employed at the home, five staff have had training on protecting vulnerable adults in last year. Three more longer serving staff spoken with were aware of appropriate steps to take should they have any concerns about a resident’s well-being. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 30 Quality in this outcome area is good. Residents are provided with a welcoming, comfortable, clean and generally safe place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ bedrooms were individual and personalised. Two bedrooms are due to be redecorated, along with the lounge, while the residents are away on holiday to minimise disruption. Information received in the pre-inspection questionnaire confirmed that residents would be supported to participate in the colour schemes, including with the use of advocates. The acting manager advised that a new bath is to be fitted and the office is also to be redecorated The premises is purpose-built. Residents, all of whom are wheelchair users, have access to all communal spaces including the lounge, dining room, kitchen and the garden. New carpets have been fitted in some areas. Storage space was limited and the bathroom was again being used to store equipment. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 18 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): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. Residents were cared for by committed and trained staff. Evidence was not provided that residents were protected by the homes recruitment procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre-inspection questionnaire advised that 4 of the 17 support staff had achieved NVQ level 3, and four others were currently undertaking it. Staff spoken with confirmed the adequacy of the current staffing levels of three staff each day. Comments received from relatives regarding the staff were complimentary and they felt that the staff had the right skills to look after the residents properly. The only concern raised was the use of agency staff and a stated observation that residents do not relate to agency staff in the same manner as with the permanent staff. Observations of staffs’ approach to, and interactions with, residents throughout the site visit were noted to be positive and caring. The agency staff member on duty confirmed that they had worked at the home on previous occasions and were observed to address residents by name. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 19 The roster copy provided at the site visit did not include the hours to be worked by some ancillary staff. It did not include the name of the agency member of staff on duty. It is hoped that the recent recruitment of permanent staff will reduce the need for agency staff. The acting manager advised that requested staff recruitment files were not available on site for inspection but were at head office. A letter of concern was subsequently issued to Hamelin Trust who responded that acting manager had misunderstood and was referring to the recently recruited night relief staff. Rosters indicated that at least two of those staff were currently working at the home and one was on duty at the time of the site visit. The acting manager advised that Hamelin Trust provide all staff with a sevenday induction training programme. While the induction workbooks were not available on the files sampled for recently recruited staff, certificates were available confirming various training including safer people handling, food safety, communication, fire safety, protection of vulnerable adults, first aid and basic health and safety awareness, and care standards and learning disability awareness. The training record provided demonstrated that the acting manager and nine care staff attended training on sensory impairment recently, a positive development since the last inspection. The acting manager advised that all staff were awaiting training on diabetes, an identified resident need. All staff are advised as having had epilepsy training as part of their seven-day induction but the acting manager advised that not all staff have had training on the administration of rectal diazepam as yet. While a list of recent and planned training was available, advice was provided on having a training profile/assessment on file for each member of staff, to aid with planning and that would feed into a development plan for the home, and would also form part of a quality monitoring system. The acting manager advised that staff were not being provided with supervision currently. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 Quality in this outcome area is adequate. Residents live in a home that is improving in the effectiveness of its management that needs to continue to ensure resident best interests. Residents/advocates can expect improving opportunity to express their views about the service. Residents were not best safeguarded by some health and safety aspects. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 306 Southend Rd has not had a registered manager in post for some years, instead having a series of acting managers who have not become registered. The acting manager advised that she has achieved NVQ Level 4 in Care, and while having a range training and experience, had no experience or training/ qualification as a manager and limited experience of residential care. She has been in post as the acting manager for 12 months, but Hamelin Trust have not yet made a formal application to the commission proposing her registration. The acting manager advised that she is currently completing the application. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 21 The acting manager stated that she had not received the seven-day induction offered to other staff. Since coming to this home she has also attended first aid, health and safety, gastronomy feed, pova, safer people handling and sensory training. The acting manager advised of limited recent supervision and support. The chief executive of Hamelin Trust advised that following a recent appointment, more direct support will be available to the acting manager. The acting manager and that she has three supernumerary shifts each week to allow her to undertake managerial tasks. She also confirmed the benefits of having been provided with sixteen hours administrative support each week. Staff spoken with said the acting manager is approachable and supportive. Hamelin Trust had undertaken monthly visits to the home and completed reports as required under regulation 26. The acting manager stated that there was no quality monitoring system available in the home, and some basic advice was provided. The chief executive advised that the Project Management Group was going to be re-established, which includes parents and will meet bi-monthly. The acting manager advised that for the majority of residents, their benefits are paid to Hamelin Trust who then pay the money into residents’ individual accounts. A cash float is maintained that is used to pay, for example for meals on outings, and any amount above £2.50 is then deducted from the individual resident accounts by Hamelin Trust. Parents are sent a monthly statement. Those sampled demonstrate expenditure for haircuts, meals out, attendance at a circus, and taxis with escorts. The acting manager advised that some residents had contributed from savings to the purchase of the new minibus, with their parents’ agreement, that receipts had been issued to the parents concerned but the vehicle is registered as owned by Hamelin Trust, and is used by all residents. It was advised that written records and a formal policy and procedure be available relating to this. Current safety inspection certificates were available in relation to the electrical fixed wiring and the gas. The available certificates relating to the chlorination of the water system, the fire alarm and the emergency lighting had expired. Monthly checks had been undertaken of the fire bells, emergency lights, doors and exits. Evacuation logs record monthly entries including the time of day and the staff present. The acting manager advised that they do not undertake checks of the water, hot or cold, as they have no thermometer. The acting manager was advised to undertake risk assessment on the outward opening toilet doors, particularly as one resident crawls on the floor to mobilise. Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 22 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 3 3 X 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 2 3 2 X 2 2 X Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA19 YA20 Regulation 15 12(1)a 13(2) 13(5) Requirement So that residents are cared for consistently and safely, care plans must identify all their assessed needs, including medication and all aspects of health care and must provide staff with sufficient information to enable them to offer residents proper and consistent care and assistance. Timescale for action 23/05/07 2. YA20 13(2) 23/05/07 So that residents are safeguarded, medication must be safely managed, including arrangements for the safe handling, storage, recording and administration of medication. This refers to the issues raised in the body of the report. Previous requirement of 14/02/06 and 14/10/06 not met. 3. YA33 18 and Sch 4 To show that there are adequate staff to meet residents needs, the hours worked by staff must be recorded, and the roster must contain the name of all staff including agency staff. 23/05/07 Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 24 4. YA34 17(2) & Sch 2 To safeguard residents, records must be maintained in the care home, as required by regulation and schedule to show that all appropriate references and checks on staff have been obtained. To benefit residents and the quality of support offered to them, all staff must be provided with training appropriate to the work they are to perform, including those identified in the report, for example medication. This also includes reference to ensuring evidence of induction is available. To benefit residents and the quality of support offered to them, staff must be appropriately supervised and supported. So that service users are provided with quality care outcomes, the quality of the care provided must be monitored and the registered provider must establish and maintain a system reviewing the quality of care at the home that involves all stakeholders and produce an annual development plan for the home. Previous requirement of 14/12/06 not met. 23/05/07 5. YA35 18 & Sch 4 01/08/07 6. YA36 18(2) 01/08/07 7. YA39 24 01/09/07 8. YA42 13(4) To ensure residents’ safety, regular checks need to be kept on the water temperatures and/or safety inspections must be kept up to date/arranged including for the fire alarm and emergency lighting. DS0000018121.V340005.R02.S.doc 23/05/07 Southend Road (306) Version 5.2 Page 25 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 Prospective users of the service should have better information in the service user guide and the statement of purpose should be reviewed. A logging system and recording format should be provided to ensure concerns are recorded and confidentiality maintained. The homes communal bathroom areas should not be used for storage. Outstanding recommendation from last inspection. 50 of staff should be trained to NVQ level two or above. Work towards developing a training and development plan for the home and individual staff should be progressed. Outstanding recommendation from last inspection. The acting manager should consider undertaking training on management to support her in her role. The registered provider should ensure that an application for a registered manager for the home is submitted to CSCI at the earliest opportunity. Outstanding recommendation from last inspection. Records are recommended to be maintained regarding the contributions made by/on behalf of residents to the purchase of Hamelin Trusts minibus. To protect residents, risk assessments and appropriate action should be taken in relation to the outward opening doors of the WC. 2. YA22 3. YA28 7. 8. YA32 YA35 9. 10. YA37 YA37 11. YA41 12. YA42 Southend Road (306) DS0000018121.V340005.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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