Inspection on 12/12/05 for Emerton Close

This inspection was carried out on 12th December 2005.

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

Other inspections for this house

Emerton Close 17/05/07

Emerton Close 01/08/05

Emerton Close 23/03/05

Emerton Close 21/12/04

Emerton Close 19/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Emerton Close 1 - 3 Emerton Close Bexleyheath Kent DA6 8DW Lead Inspector Elizabeth Brunton Unannounced Inspection 12th December 2005 11:30 Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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 Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Emerton Close Address 1 - 3 Emerton Close Bexleyheath Kent DA6 8DW 0208 303 4940 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) MCCH Society Limited Mrs Rebecca Wilde Care Home 12 Category(ies) of Learning disability (12), Physical disability (12), registration, with number Sensory impairment (4) of places Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2005 Brief Description of the Service: Emerton Close is operated by MCCH Ltd and provides care for twelve adults with profound learning and physical disabilities, sensory impairment and complex needs. The home consists of three bungalows in close proximity to each other. Houses 2 and 3 each have two single bedrooms and a shared twin bedroom. House 1 has three single bedrooms. All three bungalows have one bathroom, a separate toilet, kitchen/diner and a lounge. Each bungalow has a small garden and there is limited parking space at the front of the buildings. An office and a sensory room are located in separate buildings. On the days of inspection, there were three service users resident in each of houses 1 & 3 and four resident service users in house 2. One of the resident service users in house 2 was currently in hospital. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 11.30am. One inspector was in the home for six hours and spent most of this time in houses 1 and 2. House 3 was visited briefly. Most of the resident service users were met and their care observed. However, it was not possible to find out service users’ views about the service provided in the home, due to communication issues. One visiting relative was spoken to and six relatives completed pre-inspection questionnaires. Pre-inspection questionnaires were also completed by a community nurse and an advocate. The registered manager and other staff on duty during the day were spoken to. The communal rooms, garden and service users’ bedrooms were seen. Records were looked at, including some service users’ individual case files. What the service does well: What has improved since the last inspection? What they could do better: Service users still did not have proper contracts for their residence in the home, which set out exactly what services would be provided. Staff needed to be recruited as soon as possible to fill vacant posts and staff should be given all the necessary training. All service users needed to have regular dental and optical checks and care plans for the prevention and care of pressure ulcers Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 6 were needed. Staff were doing well at giving PEG feeding but some additional records were needed. Uneven paving slabs, an unsafe carpet and a faulty refrigerator needed attention and maintenance and repair work should be promptly carried out. 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. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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 Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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): 2, 3 & 5 Information about service users was on file but contracts were still needed, in order to provide full information about the services to be provided. A new service user had settled well into the home. EVIDENCE: As at previous inspections, there was much information about service users on file, including their needs, likes & dislikes. Staff had continued to meet service users’ needs, including their complex health care needs. All relatives who completed pre-inspection questionnaires and a relative spoken to, said they were satisfied with the care provided in the home. A new service user had moved into house 3 since the last inspection. A member of staff had gone to meet her in her previous home and introductory visits were planned. However, the service user then had to be admitted in an emergency and straight from hospital, so introductory visits could not take place. She appeared to have settled well and to be content. Her mother, who had been understandable anxious about her daughter’s move, had been given the opportunity to talk to the relative of another resident service user. Comprehensive contracts for service users were still needed. Relatives and their relatives or representatives need clear information about the terms and conditions of residence in the home. (see requirement 1) Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Goals had been set with service users at regular planning meetings. Risk assessments had been undertaken and service users had been encouraged to lead full lives and to make choices. EVIDENCE: Regular individual planning meetings had continued to be held with service users and their relatives, at which varied and achievable goals had been set. Daily records were maintained for each service user but some were still brief, limited in content and with gaps. Staff may need training in this area. (see recommendation 1) Staff spoken to were committed to giving service users choice and ascertaining their views, wherever possible and were seen to do this on the day of inspection. The manager and staff had advocated for service users, particularly in relation to health care and complaints had been made on their behalf. Good use had also been made of the local advocacy service. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 10 Risk assessments were seen on file and service users had been supported in going out, taking part in activities and in leading as full and independent lives as possible. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Service users were supported in taking part in varied activities, maintaining contact with their families and friends and in having some involvement with the local community. Varied and nutritious meals had been served and the necessary assistance given. Some additional recording in support of PEG feeding practice and more regular monitoring of some service users’ weights, were needed. EVIDENCE: Staff had continued to support service users in taking part in activities inside and outside the home. Some service users attended day centres on a number of days each week. Staff are to be commended for enabling service users to continue with activities, while providing intensive care to other service users with complex healthcare needs. Service users used local shops and other facilities and went for walks in the local area. Relationships with neighbours and other local people were said to be cordial but extensive community involvement was difficult to achieve. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 12 Most service users were in regular contact with their families and some had contact with past carers and friends. Some service users spent regular weekends at home with their families and some relatives visited the home daily and participated in caring for their service user. Relatives who completed pre-inspection questionnaires and a relative spoken to on the day of inspection, all confirmed that they could visit at any time and were made welcome by staff. All but one of these relatives also confirmed that they were kept informed and consulted about service users’ care. Service users’ independence and freedom of movement were inevitably limited by their disabilities. Staff were seen to talk and interact with service users throughout the day of inspection and to address service users and to talk about them in a courteous and friendly manner. Personal care was carried out discretely and service users’ privacy and dignity were maintained. Records showed that varied and nutritious meals had been served. Assistance with feeding was sensitively given and eating and drinking guidelines were in place for a number of service users. Records showed that service users’ weight had been monitored but this had not always been as regular as recommended by the dietician/eating and drinking clinic. A number of service users received PEG feeding and staff competency and training in administering this was inspected earlier in the year. Care plans for PEG feeding were also inspected but the need for regular reviews of these, the inclusion of mouth care, relatives’ written consent to PEG feeding and risk assessments were still needed. (see requirement 2 and recommendations 2, 3 & 4) . Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 21 Complex health care needs had been well met but regular dental and optical checks must be ensured. Medication was safely stored and properly administered. Excellent terminal care had been given to one service user. EVIDENCE: Service users’ complex health care needs had continued to be well met, with support from outside health care professionals. The managers and staff are to be commended for the support they were giving to one service user, who was currently in hospital. Information concerning service users’ health care needs was on file and health care appointments had been recorded. However, regular dental and optical checks had not been recorded for all service users in houses 1 and 2, whose files were inspected. (see requirement 3) Pressure sore risk assessments had been recorded but were retained on the wrong files in house 2. One service user in house 2 had recently developed a pressure sore. The district nurse was said to have been consulted and to have arranged for a pressure-relieving mattress to be provided on the same day. However, there was no written care plan in place and staff spoken to were not aware of any instructions given by the district nurse. The MCCH clinical nurse specialist recently gave a talk to staff on the care and prevention of pressure sores. (see requirement 4) Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 14 One service user had recently had an ileostomy and most staff had already been trained and accredited in caring for this. Staff spoken to were confident about undertaking this additional area of work and confirmed that only trained and accredited staff were expected to undertake it. Another service user occasionally required oral suction and staff were being trained to provide this. Medication was inspected in houses 1 and 2, where it was safely stored. Sample checks of medication and administration records were made in each house and were all satisfactory. Protocols were in place for PRN medication and homely remedies were said not to be given. A service user, who had lived in house 3 for many years, had recently remained at home until she died. Staff were giving excellent care to this service user at the last inspection. The managers had participated in caring for her and there had been good support from the MCCH clinical nurse specialist and Ellinor nurses. The service user’ funeral had been held from the home and staff had received debriefing afterwards. The relative of another resident in house 3 said that ‘staff gave fantastic care’ to this service user. The managers and staff are to be commended for this. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Relatives had been told how to complain and service users were protected from harm and abuse. EVIDENCE: There had been no complaints since the last inspection. All relatives who completed pre-inspection questionnaires confirmed that they were aware of the home’s complaints procedure. One adult protection concern had been reported since the last inspection. It had been investigated by the registered manager and the necessary disciplinary action taken against the member of bank staff, who would not be returning to work at the home. As at previous inspections, staff spoken to were aware of safe practice and committed to the protection of service users. The managers were in close touch with service users, staff and with day-to-day events in the home. Staff spoken to had not received recent training in adult protection but were said to be booked onto courses in the near future. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The home was sufficiently spacious, comfortable and generally clean and well maintained. The carpet in house 1 required attention and maintenance work needed to be promptly carried out. EVIDENCE: The building was generally clean, well decorated and maintained and was sufficiently spacious for the number of service users. Gates to the property had now been fitted but the uneven paving slabs between houses 2 and 3 still needed attention. Attractive Christmas decorations were in place in all three houses and in the garden. (see requirement 5) House 1 had recently been refurbished to a high standard and some rooms in the other houses had been redecorated or were in the process of being redecorated by staff. Bedrooms were personalised, well decorated and furnished. The furniture in the shared bedroom in house 2 was being replaced but the bathroom in this house still needed attention. The carpet in house 1 needed to be secured at doorways as soon as possible, as it was currently a risk to the health and safety of service users and staff. The registered manager said that the carpet had been risk assessed and reported to MCCH on an almost daily basis. Tall trees overhanging the office and drive needed Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 17 cutting back or removing, as service users and staff could trip on the falling leaves, which were also blocking the gutters. The registered manager said that negotiations were taking place with the council over these trees and staff were sweeping up the leaves. However, the gutters needed clearing. Staff and a relative again reported long delays in necessary maintenance and repair work being arranged by MCCH. The carpet in house 1 and the blocked gutters are examples of this. Ramps to the doorways of each house were also needed. (see requirements 6 & 7 and recommendations 5, 6 & 7) Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 The home was adequately staffed by a committed, able and well-supported staff group, who had recently taken on additional responsibilities. Staff vacancies needed to be filled. Some additional staff recruitment records needed to be kept in the home and some staff supervision and training were outstanding. EVIDENCE: Staff on duty were competent and committed and communicated well with service users. All relatives who completed pre-inspection questionnaires said they were satisfied with the care provided in this home. An advocate commented that staff were ‘very service user focused’. Staff are to be commended for their positive approach to learning new skills and to the additional responsibilities undertaken. It is hoped that staff will receive some financial recognition of this. (see recommendation 8) Staffing levels appeared to be adequate and this was confirmed by most relatives who completed pre-inspection questionnaires. There were four staff vacancies but seniors were now in post in all three houses. Two staff had also been seconded to work for several months in another MCCH home, which was very short staffed. Bank staff had regularly been used to cover shifts and Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 19 agency staff less often. Vacant posts must be recruited to without delay. (see requirement 8) Staff recruitment records were stored at head office but a sample of those retained in the home were inspected. The necessary information was in place, apart from copies of staff references. (see requirement 9) Staff had received recent in-house training in fire safety and moving and handling. Training had also been provided in infection control and health facilitation. Training in food hygiene and adult protection was outstanding but staff were said to be booked onto adult protection training courses in the near future. Forty percent of the care staff had an NVQ level 2 or 3 qualification. There was said to be delay of a year or more before some bank staff received their foundation training, including training in moving and handling. (see requirements 10 & 11 and recommendation 9) Though records were not checked on this occasion, senior staff and staff in houses 1 and 3 were said to have been receiving regular 1:1 supervision. House 2 had been without a senior for several months and staff spoken to in that house said they had not received 1:1 supervision during the past six months. However, staff confirmed that they were well supported by senior staff, who were always accessible to them. (see recommendation10) Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 The home was very well managed but visits by the provider needed to be more regular. The health and safety of service users had been protected but some additional measures were needed. EVIDENCE: The management structure in the home had recently changed. In addition to the manager post, there was now a service co-ordinator, who was also the registered manager. The home was very well managed by able staff. Evidence that the views of service users underpin all self-monitoring, review and development by the home, was not available and MCCH are asked to provide this. The home had been visited by the provider since the last inspection but not each month, as required. (see requirement 12 and recommendation 11) Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 21 The building appeared to be safe, apart from the uneven paving slabs and the carpet in house 1, as previously mentioned. No other hazards or risks to the safety of service users were identified. The registered manager confirmed that fire safety equipment had been checked and serviced by the contractor in June 2005. Fire safety records were inspected in house 2, where fire alarms and emergency lights had been regularly tested and fire drills had been held four times during the past year. The gas installation and equipment was said to have been checked by the contractor in December 2004 and electrical equipment in September 2005. Hoists had been checked and serviced by the contractor every six months. Food seen in house 2 was correctly labelled and stored but the refrigerator temperature had regularly been above the safe maximum temperature during the past few weeks. This was said to have been reported to MCCH on a number of occasions but no action had yet been taken. (see requirement 13) Moving and handling risk assessments were in place for service users but those seen did not appear to have been reviewed regularly. Staff spoken to were aware of safe practice. All service users had cot sides to their beds but the use of these had not been risk assessed. (see requirements 14 & 15) Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 X 1 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Emerton Close Score X 3 3 4 Standard No 37 38 39 40 41 42 43 Score 4 X 2 X X 2 x DS0000038187.V272247.R01.S.doc Version 5.0 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 YA5 Regulation 5(3) Requirement Each service user must be provided with a copy of their contract/statement of terms and conditions of residence in the home, which includes all the matters listed under this standard. (This has been outstanding since April 2002) Mouth care must be included in care plans for those service users receiving PEG feeding. (Previous timescale of 01/10/05 not met). Service users must have regular dental and optical checks. Care plans for the prevention and care of pressure ulcers must be provided, where needed and risk assessments must be retained on the right files. (Previous timescale of 01/10/05 not met). The uneven paving slabs between houses 2 and 3 must be risk assessed and the necessary action taken. (Previous timescale of 01/11/05 not met). The carpet in house 1 must be properly secured at doorways. Maintenance and repairs must be DS0000038187.V272247.R01.S.doc Timescale for action 01/03/06 2. YA17 15(1) 01/03/06 3. 4. YA19 YA19 15(1) 15(1) 01/03/06 01/03/06 5. YA24 13(4) 01/03/06 6. 7. YA24 YA24 13(4) 13(4) 01/02/06 01/02/06 Page 24 Emerton Close Version 5.0 8. 9. 10. 11. YA33 YA34 YA35 YA35 18(1) 17(2) 18(1) 18(1) 12. 13. 14. 15. YA39 YA42 YA42 YA42 26 13(4) 13(4) 13(4) carried out promptly, particularly where there is a risk to the health and safety of service users and staff. Recruitment of staff to fill vacancies in the home must be given priority. Copies of staff references must be retained in the home, in line with schedule 4. Staff must be provided with regular update training in food hygiene and adult protection. Bank staff must receive foundation training, including training in moving and handling, soon after starting work. Monthly visits must be made to the home by the provider. The refrigerator in house 2 must be repaired/replaced. Moving and handling risk assessments must be regularly reviewed and updated. The use of cot sides must be risk assessed. 01/03/06 01/03/06 01/03/06 01/03/06 01/03/06 01/02/06 01/03/06 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA6 YA17 YA17 YA17 YA24 Good Practice Recommendations Daily records should be comprehensive, informative and regularly recorded. The necessary training should be provided for staff. The signed consent of relatives to service users receiving PEG feeding from care staff, should be obtained. All care plans for PEG feeding should be regularly reviewed. A risk assessment of PEG feeding in the home should also be recorded. Service users’ weight should be monitored as regularly as recommended by the dietician/eating and drinking clinic. The floor covering and tiling in the bathroom in house 2 DS0000038187.V272247.R01.S.doc Version 5.0 Page 25 Emerton Close 6. 7. 8. 9. 10. 11. YA24 YA24 YA33 YA32 YA36 YA39 should be repaired/replaced. The guttering should be cleared of leaves. Ramps should be fitted to the front doors of each house. Some financial recognition should be made of the additional health care responsibilities and training recently undertaken by staff. Additional NVQ training should be provided, so that at least half the care staff hold this qualification. Staff should receive regular 1:1 supervision. MCCH are asked to provide CSCI with information about the self-monitoring, review and development plan for the home. Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Emerton Close DS0000038187.V272247.R01.S.doc Version 5.0 Page 27 - 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. 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