Inspection on 20/11/06 for 89 Thanington Road

This inspection was carried out on 20th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

89 Thanington Road 29/08/08

89 Thanington Road 21/08/07

89 Thanington Road 23/02/06

89 Thanington Road 07/01/05

89 Thanington Road 09/06/04

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

CARE HOME ADULTS 18-65 89 Thanington Road Canterbury Kent CT1 3XD Lead Inspector Jenny McGookin Key Unannounced Inspection 20th November 2006 10:00 89 Thanington Road DS0000023728.V312504.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 89 Thanington Road DS0000023728.V312504.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. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 89 Thanington Road Address Canterbury Kent CT1 3XD 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) 01227 764881 thaningtonrd@mcch.org.uk MCCH Society Limited Mrs Janine Lesley Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: This home is a large domestic style dwelling that has been adapted to meet the requirements of a residential care home catering for people with a learning disability. The registration details show that Mr Gordon Boxall is representing Methodist Community Care Housing (hereafter referred to as MCCH) Society Limited as the Responsible Individual, and Mrs Janine Lesley is shown as the Registered Manager, although Tracey Beale was acting manager at the time of this site visit. The home was originally registered to accommodate 5 service users, but the conversion of one double bedroom into a single occupancy room effectively reduced its capacity to 4 users, and the home has in practice been operating with three service users for some time. This should be reflected in the formal registration details. One bedroom is sited on the ground floor within easy access of a WC/ shower room. The other bedrooms are on the first floor. Although there are ramps to the front and rear of the property and there are some grab rails, access to the rest of the premises has not otherwise been adapted to facilitate access for individuals with mobility impairment. The home has a garden at the back where service users can pursue leisure and social activities or horticultural hobbies. The home is about a mile from Canterbury city centre and all the community and transport links that implies, and the home is also on a bus route to Ashford as well as Canterbury, although the nearest bus stop is about 500 yards walk away There is an on-site parking bay for up to seven vehicles as well as unrestricted kerb-side parking on Thanington Road. The service users have had access to a Motability vehicle, the local “Park and Ride” service, and staff vehicles are also used to access the community. The current fees for the service at the time of the visit are £1,154 per week. Information on the home’s services and the CSCI reports for prospective residents should be detailed in the Statement of Purpose and Resident Guide. The e-mail address for this home is: thaningtonrd@mcch.org.uk 89 Thanington Road DS0000023728.V312504.R01.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 site visit, which was intended to inform this year’s key inspection process; to review findings on the last inspection (February 2006) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion. The inspection process took seven and a quarter hours, and involved meeting with the visiting service co-ordinator; the acting manager, three support workers, and a student nurse on a placement. The inspection also involved a complete tour of the premises and the examination of a range of records. A service user’s file was selected for care tracking. Conversations with the residents were not possible because of their level of disability, but interactions between staff and the residents were observed during the day. What the service does well: What has improved since the last inspection? What they could do better: Decisions not to provide furniture and fittings in bedrooms must be recorded. MCCH needs ensure staff obtain NVQ accreditation. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 6 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. 89 Thanington Road DS0000023728.V312504.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 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Although there have been no new admissions, policies are in place to ensure this is managed appropriately. Each placement is subject to terms and conditions governing the rights and responsibilities of both parties. EVIDENCE: All three service users were admitted to the home in 1991 and the inspector was advised that there are no further admissions being actively planned. The inspector was satisfied that MCCH can demonstrate the home’s capacity to meet the assessed needs of current service users. In common with the arrangements in other homes in the group, MCCH has a contract with the commissioning agencies, which is kept at its headquarters (i.e. not accessible to the inspection). There is also an “Assured Shared Tenancy Agreement for Supported Housing” which the inspector had already assessed as largely compliant with the standard insofar as it describes the landlord / tenant arrangements and the terms and conditions, fees and facilities governing each tenancy. This document is written in generally plain language, so as not to alienate the 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 9 general public, and this document has an appendix, which was designed to obtain further compliance with this standard (e.g. re committing the MCCH to provide personal care, care planning / review process). It is likely that any prospective residents would have special communication needs, which would need to be catered for. 89 Thanington Road DS0000023728.V312504.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: Each service user has to have, as a condition of their admission, a Care Coordinator or a Local Authority Care Manager, and the care plans they set up in the first instance. The formats of these care plans provide scope for all aspects of the health, personal and social care needs of the service user to be addressed, and each service user has an allocated key worker to ensure they are implemented and developed thereon. The review processes for these service users are led by a Community Nurse (Learning Disabilities), with input from the service user’s key worker, and records show they are being reviewed every six months. In each case, the records show that the service user is invited to participate and whether they stay for the whole meeting. And other interested parties such as family members are also routinely invited. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 11 The inspector was satisfied, that service users were being supported to make their own daily living decisions. The inspector found good evidence of risk assessments governing a range of activities inside and outside the home. And there was evidence of their recent review, to ensure they keep pace with progress being made towards greater independence. MCCH has been able to demonstrate its commitment to supporting service users to make best use of their more ambitious lifestyle choices - one service user from this home was moved onto more independent living to good effect. The inspector was generally satisfied with the home’s arrangements for keeping confidential information secure against unauthorized access. 89 Thanington Road DS0000023728.V312504.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12,13,15,16,17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: This home is judged reasonably well placed in terms of access to Canterbury City Centre and all the community resources and transport links that implies. The inspector was satisfied that daily routines promote independence, individual choice and freedom of movement, subject in each case to risk assessments, so that the service users stay safe. The current service users are reported to be able to understand the spoken word but have limited communication skills. The home’s own staff provide some direct support, but also rely on outside agencies and the Visiting Persons 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 13 Team for support with other activities. In each case, staff use a range of skills to support them with making choices over their activities. These activities range from ordinary everyday events such as light housework tasks (cooking, laundry, tidying and gardening) and on site activities such as puzzles, art, TV, videos and DVDs. There are local outings (bowling, rambling, swimming, shopping, cinema, clubs, banking, meals out and sensory sessions in a day centre) i.e. socially inclusive activities not restricted to their disability. And there are ambitious undertakings like holidays abroad, and trying activities such as skiing, a parachute jump and a helicopter ride – as reported on in the last inspection earlier in the year. The service users’ scope for access to friends and relatives is promoted by this home. There are open visiting arrangements, and records confirm the active involvement of relatives in the care planning processes. There is a communal phone in the hallway and service users would also have access to the office phone, though they would in each case require staff support because of their limited verbal skills. 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 residents and eat the same food, which is judged a good quality assurance tool. During the site visit, the inspector joined the service users and staff for lunch and judged the meal well prepared and presented. The service users were clearly used to having their meal together – though one chose, in this instance, to eat in another room and was supported to do so. The pace of the meal was unhurried and the atmosphere was relaxed and congenial. Service users can snack between meals, and can participate in the preparation of meals, subject to risk assessment. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. 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 resident requires assistance with their own personal care, and their choice and control is actively promoted by staff as far as possible. In most cases this simply amounts to prompts. All the 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 residents, should they require help. The care planning process routinely addresses a range of standard healthcare needs and records have been set up on file to document access to healthcare professionals as appropriate e.g. GP, community nursing, optician, dentist etc. so that trends and events can be properly tracked. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 15 Records confirm that none of the service users is currently judged able to self medicate. The medication administration records seen showed no anomalies or gaps and the inspector was advised that the home keeps medication reference material on site. Staff confirmed they had received recent training. The medication arrangements were, therefore, judged compliant with the National Minimum Standards and found to be in the service users’ best interests. 89 Thanington Road DS0000023728.V312504.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and would be supported to use the home’s complaints procedure, if required. They are protected from abuse, and have their rights protected. EVIDENCE: MCCH has policies on complaints and adult, which have been judged satisfactory by previous inspections and feedback obtained at the last inspection (February 2006) confirmed that residents and relatives knew who to tell if they were dissatisfied about anything and that residents felt safe. The MCCH also a picture-assisted version of the complaints procedure to make it more accessible to residents, and records include a checklist for staff to sign and date as confirmation of their having explained the complaints procedure to the residents. The inspector was advised that there have been no complaints registered since the last inspection. The absence of recorded complaints is not, however, judged a realistic reflection of day-to-day life, given the special needs and interactions of the residents. The challenge continues to be to find ways of translating any expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can evaluate the extent to which their responses are listened to and acted on. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 17 There is currently no active input from independent advocacy services, though the inspector understands MCCH has information on local resources so that arrangements could be put in place. In meetings with the inspector, staff confirmed having had training in a range of pertinent issues such as adult protection, manual handling, personal safety over the past year, and reaffirmed their commitment to challenge and report any instances of abuse, should they occur. See also section on “individual Need and Choices” in respect of risk assessments and ”Conduct and Management of the Home” in respect of health and safety. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home’s location (in terms of access to Canterbury) and layout are generally suitable for its registered purpose, and measures are in place to keep the premises secure against unauthorised access or egress. All areas of the home were inspected and found to be homely, comfortable and generally clean. Comfortable temperatures and lighting levels were being maintained. The furniture tends to be domestic in style and there were homely touches throughout, including the service users’ own pieces of art and craft work and photographs. The grounds are reasonably flat (i.e. no outstanding trip or slip hazards) throughout, so that service users can use them with safety, and the garden is landscaped to provide pleasant outlooks from the bedrooms. The home has a “No Smoking” policy. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 19 The communal areas of this home are spacious. All the bedroom windows offer pleasant outlooks. The seating in the dining and lounge areas is uniform in style, but this is appropriate, given all the residents are relatively mobile (one uses a wheelchair outside). The kitchen is light, airy, clean and well maintained, accepting it is scheduled to be refurbished next spring. There is one communal bathroom, and a shower room/WC and WC i.e. reasonably accessible to bedrooms and communal areas. All the bedrooms are single occupancy, so that service users are assured of privacy. All the bedrooms were inspected and judged well maintained and personalised. In terms of their furniture and fittings, they were, however, generally not fully compliant with all the provisions of the National Minimum Standards. While their non-provision was justified, this needs to be supported by fully documented consultation and risk assessment. All the maintenance records seen were generally up to date and systematically arranged – only one certificate was outstanding. A few matters were raised for consideration or attention, to improve the facilities and level of hygiene. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,3334,35,36 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Staff in the home are skilled and in 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. But MCCH needs to obtain compliance with the requisite level of NVQ accreditation to meet the National Minimum Standard. EVIDENCE: The staffing arrangements at this home were judged sufficient to meet the assessed needs of the residents. And an examination of staffing rotas for the four week period 9-22 October 2006 indicated that this was representative. The manager is available to provide direct care (which is being used to good effect as a quality assurance tool as well as an opportunity to build up a rapport with service users and staff) but is allocated one day a week to carry out purely management tasks There are no ancillary staff, though MCCH has its own maintenance department - support workers are responsible for cleaning the home and also have some grounds maintenance tasks. They are to be commended on the level of cleanliness found. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 21 An examination of personnel records confirmed a robust recruitment process to comply with all the key elements of the standard. Staff confirmed that they had supervision sessions, though the frequency of this varied from 2-8 weeks (i.e. in excess of the National Minimum Standard), and that these sessions covered all those elements prescribed by the standard: specifically, the translation of the home’s philosophy and aims into work with individuals; monitoring or work with individual residents; support and professional guidance; and the identification of training and development needs. Staff training records were inspected on this occasion, which confirmed information obtained from staff and previous inspections i.e. that there is a satisfactory level of investment in mandatory training (e.g. moving and handling, medication, food hygiene, First Aid and Health and Safety, COSHH and infection control) to keep the service users safe, as well as some specialist training such as epilepsy, loss and bereavement, and care planning. However, something like 14 of staff are currently reported to be accredited to NVQ Level 2 or above. This must be addressed as a priority, in order to maintain parity with expected standards – though the inspector does not judge the service users’ safety and well-being are in any way being compromised. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, but there needs to be more effective quality assurance systems. EVIDENCE: The inspector judged the Co-ordinator’s experience and management style were generally appropriate to her role; and that pending the submission of her application for re-registration as the manager for this home, suitable arrangements had been made to cover the manager’s post with the deputy. The operation of this home will benefit by consistency of management. The inspector also judged that the structure of the overall organisation offered generally clear lines of accountability, and generally good use has traditionally been made of the regulatory framework to keep service users safe and to promote their well being. . 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 23 This is a mixed gender team, which reports working harmoniously and flexibly to meet the needs of the residents. The residents all require prompting with their personal care, and the deployment of staff is organised to meet their needs and preferences (e.g. same gender care). The inspector judged the processes for managing this home open and transparent, and judged the delegation of responsibilities appropriate. There was good evidence of residents being supported to make choices on a day-to-day basis, and there was information of a recent mailshot to obtain feedback from relevant stakeholders, though it was judged too soon to evaluate its effectiveness as a quality assurance tool. Since May this year, there was good evidence of the MCCH carrying out monthly inspection visits of its own, but practice before then has been variable. MCCH has a corporate business plan, but this unit needs to set up its own business plan, to reflect local provision and resources – this needs to be linked to quality assurance initiatives and corporate business planning and auditing arrangements, to obtain full compliance with this standard. The interpreted views of service users and feedback from other stakeholders will be crucial to the success of this. See standard 22 on complaints. The challenge will be to demonstrate, through proper record keeping, that issues causing dissatisfaction are listened to and acted upon. Records confirmed regular health and safety audits. The home appeared to be generally very well maintained and hazard free. With one exception (certificate expected) all maintenance records were up to date and systematically stored, so that service users remain safe. 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 24 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 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 4 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 25 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 YA26 Regulation 16(2)(c) Requirement The non-provision of bedroom furniture and fittings prescribed by the National Minimum Standard must be justified in each case by documented by risk assessments and/or consultation. Timescale for action 31/12/06 2 YA35 18 The registered person needs to 31/12/06 obtain compliance with the National Minimum Standard in respect of the percentage of staff with NVQ 2 accreditation, or above. Action plan to be submitted 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 YA22 Good Practice Recommendations The challenge continues to be to find ways of translating any expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can DS0000023728.V312504.R01.S.doc Version 5.2 Page 26 89 Thanington Road evaluate the extent to which their responses are listened to and acted on. 2 YA24 Building – the following recommendations are made to improve the facilities and hygiene: • Kitchen refuse should be stored in lined and lidded bins • 1st floor WC –very restricted space. Recommend removal of wall separating the WC from bathroom / WC. Needs to be kept supplied with soap and soft paper towels with a lidded bin • Bathroom and Shower room – would benefit by refurbishment; radiators showing signs of rust, require attention or replacement; paintwork was peeling off in bathroom; Shower attachment – needs a “non-return” valve to stop feedback. Bathroom furniture needs updating and doesn’t match; shower cubicle needs through clean. • The linen on one bed had an old unsightly stain. One bedroom was not free of odour. • Recommend a sluice or disinfecting cycle on washing machine. • There should be a unit-specific business plan, linked to quality assurance initiatives and corporate business planning and auditing arrangements, to obtain full compliance with this standard. The views of service users and other stakeholders will be crucial to the success of this. 3 YA39 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 89 Thanington Road DS0000023728.V312504.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!