Inspection on 22/11/06 for Kemsing Road Respite Service

This inspection was carried out on 22nd November 2006.

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

Other inspections for this house

Kemsing Road Respite Service 24/05/07

Kemsing Road Respite Service 31/05/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Kemsing Road Respite Service 11 Kemsing Road Greenwich London SE10 0LL Lead Inspector Keith Izzard Key Unannounced Inspection 22 November 2006 10:00 nd Kemsing Road Respite Service DS0000062951.V311416.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 Kemsing Road Respite Service DS0000062951.V311416.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. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kemsing Road Respite Service Address 11 Kemsing Road Greenwich London SE10 0LL 01707 652053 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) Caretech Community Services ** Post Vacant *** Care Home 8 Category(ies) of Dementia (0), Learning disability (0), Learning registration, with number disability over 65 years of age (0), Mental of places disorder, excluding learning disability or dementia (0), Physical disability (0), Sensory impairment (0) Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2006 Brief Description of the Service: 11, Kemsing Road, is a new purpose built semi-detached property, offering respite care and accommodation for up to 8 Service Users at any one time. This respite care is completely flexible, and can be for as little as one night, or for several weeks, depending on the current requirements. The property was built in association with Greenwich Social Services, to provide respite care in place of other Homes which were no longer suitable. The Registered Providers and management are Caretech Community Services, who are experienced providers for these categories of care. Accommodation is provided in 2 flats of 4 bedrooms each, with one flat on the ground floor, and one on the first floor. The second floor contains office and staff facilities, the laundry, and a clinical room. Each bedroom is provided with en-suite shower facilities, and suitable equipment for Service Users with physical disabilities. The rooms on the ground floor are slightly larger, and are usually reserved for Service Users who are wheelchair bound. The 2 flats are provided with separate kitchen, lounge and dining rooms, a shared bathroom, and separate gardens at the rear of the property. These also have separate access from the Home. A passenger lift provides easy access to all floors. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two separate days on 21st and 28th November 2006 over a period of 13.5 hours. The Inspector received assistance in this inspection from the manager, deputy, a team leader and three care staff members. Over the past few months the staff of the home have been subject to an investigation carried out by the Community Learning Disability team following an unfortunate series of Adult Protection incidents. The findings of this investigation were published in a report and listed a considerable number of recommendations to address practice issues arising from the investigation. The home has already implemented many of the recommendations but there are a number that still require implementation and these have been referred to in the relevant Standards and requirements made, where necessary. The inspection included, reading documentation, for example, assessment information, care plans, and medication charts, a tour of the premises; inspecting medication procedures, and checking of information in regards to staff recruitment, training, and supervision. Five staff members were interviewed, all commented on the strains imposed by the investigation process and that staff morale had initially plummeted but was now improving commensurate with the various improvements that have either taken place or are in the process of being implemented. All staff spoken to recognised the importance of ensuring care records are brought up to date, recording events accurately and communicating more effectively between themselves, carers and outside professionals. Staff members felt that improvements had already been made and were positive that further training and support would enable them to progress to achieve the standards required. What the service does well: What has improved since the last inspection? Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 6 Medicine cabinets have been provided on each of the units. Current care files are now readily accessible on the individual units. Administrative support is on site to assist with the updating and maintenance of records and care files. Some sensory equipment has been purchased. What they could do better: On the first day of inspection an immediate requirement was made to ensure that the newly appointed night care staff were trained to administer PRN medication, if required, and immediate on call cover available until the training could be provided. This was complied with immediately. Other requirements were made; that the manager must ensure that the current review of community care assessments and the associated updating of care plans / files are completed within the timescale. The manager must ensure that arrangements for the allocation of respite care is firmly based upon whether the home can adequately meet both the individual and collective needs of the service users accommodated at any one time. Should this ever not be the case, then, the relevant individual admissions must be refused and reported to CSCI & CLDT immediately, prior to any such admission taking place. The review of the individual allocation of respite care entitlement currently being undertaken by the CLDT should assist the home to allocate resources as long as ample notice is given by CLDT to allow the necessary scheduling to take place. All risk assessments must be based on the most up to date assessments provided in writing and signed from carers, prior to any admission using the format recently produced by the home. The content of incident/ accident recording must be improved and training provided for staff members provided as a matter of priority. The Training Action Plan, recently produced, must be fully implemented as soon as practicable. Two requirements were made in respect of medication detailed within the report. Seven requirements to do with environmental issues were made, detailed within the report; two were made a priority as issues to do with the privacy Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 7 were involved, and the manager stated that he would deal with them urgently, namely securing bedroom curtains and repairing a bathroom door. Another priority was to improve the level of lighting in service users’ bedrooms, for safety reasons. A requirement was made to ensure that all staff members receive the required level of formal supervision and the supervisors receive training to perform that task and also that all staff be required to sign to say they have read and understood the new Whistle Blowing procedure. The level and variety of activities and outings was generally low and a requirement was made to review this and a recommendation made that the home employs a part time driver to facilitate this. Recommendations were also made around the provision of sensory activities for service users. In respect of staffing the manager should submit his application to become the Registered Manager, a deputy manager should be appointed as soon as possible and any vacancies for care staff be filled by permanent staff to ensure continuity for service users. 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. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose requires further revision. The staff members of the home need to work in conjunction with the Community Leaning Disability team to ensure that all service users receive updated assessments as soon as possible. EVIDENCE: Standard 1 The contact details within the Statement of Purpose and Service User Guide were amended as required at the previous inspection. However the Statement of Purpose still needs to clarify the number and relevant qualifications of staff members employed and accurately state the number of service users accommodated, see page 12. The statements regarding consultation with residents on page 7 and access to the service on page 5 should also be reviewed to ensure accuracy. The amended copy of the Statement of purpose must be sent to the CSCI as soon as it is completed. See Requirement 1 The Mission Statement recently produced could usefully be incorporated into the Statement of Purpose and Service User Guide. See Recommendation 1 Standard 2 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 10 The Inspector discussed pre-admission assessments with the Manager, and viewed documentation regarding the assessment process. Many Service Users had previously received respite care at other venues, which have been discontinued, and there are extensive historical records available for those service users. Additionally, some of the staff had been previously employed at these other establishments and this has helped with the continuity of care for some Service Users. A restated requirement was made at the previous inspection on 11th May 2006 to update all care plans, as the previous deadline of 31st December 2005 had not been complied with. It was agreed and acknowledged by the manager and the Inspector, in May 2006, that there were mitigating circumstances contributing to the non compliance but that the new timescale of August 2006 was achievable and must be completed, even if the home took sole responsibility, in the event, that the CLDT team could not achieve the reviewing necessary in conjunction with the home. Regrettably, the restated requirement was not met and the manager stated that the home had again been overtaken by events, this time the investigation that took place following four adult protection incidents and the consequent recommendation made by the Greenwich Social Services Learning Disability Team that care files and care plans be redesigned in accordance with their specification. A commitment was made following the investigation that CLDT would set up a schedule of community care reviews to assist in the development of updated assessments and care plans, determine who should receive 1:1 support workers in addition to Kemsing Road staff members when receiving respite care at Kemsing Road and totally review how many days care each service user would receive per annum. The Inspector welcomes this long overdue initiative, as this should provide a platform for Kemsing Road to update their own paperwork and rationalise the admission system to ensure the compatibility of service users using the service at any one time and ensure that staff members are not pressured into taking admissions that have not been adequately planned for. In view of this a new restated requirement has been made to ensure that all assessments and care plans will be updated by the end of February 2007 and the manager is required to report any default on this timescale to the CSCI in writing. See Requirement 2 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff members of the home need to work in conjunction with the Community Leaning Disability team to ensure that all service users receive updated assessments and care files are upgraded as soon as possible. Lockable facilities must be provided for current care files. The review of needs assessments must be completed and the review of service users’ entitlement to respite care clarified as soon as possible. EVIDENCE: Standard 6 From the assessment information a document entitled Individual Support Requirements is drawn up that specifically requires that staff members, the Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 12 service user and or their representative sign to indicate their agreement or otherwise with the plan. The Inspector examined two of the new care plans that have been drawn up in response to the requirement made at the previous two inspections. As already stated in Standard 2 the home has an ongoing programme in conjunction with CLDT to update all care plans by the end of February 2007. Three, out of six that were designated as priority cases had already been completed, as they require the additional input of 1:1 workers who have care and support needs that cannot be safely and therapeutically met within the normal staffing levels of the home. These records were found to be up to date and comprehensive and much better structured; a good response had been made to the recommendations made by CLDT in the two records that had been updated. Staff members should benefit from the greater clarity and relative ease of reference in the new records pertaining to each service user. The care records are retained individually in ring binders now named Current Files and these are now retained on the appropriate unit in the medicine cupboard. This is a good initiative to ensure records are readily available to staff members but the home must be provided with lockable cupboards on each unit to house all the information required on the residents accommodated at the time. See Requirement 3 There are also ring binders called Historical Files and these inactive files contain historical information not relevant to the current care plans; these are stored separately on the admin floor. The Home uses a set assessment format, and the Inspector looked at a completed assessment in detail. This included religious and ethnic needs, physical health and medication, and psychiatric needs. The assessment has forms to record the personal hygiene needs; skills for dressing/undressing; aids and equipment needed; toileting needs; nutrition, feeding and dietary requirements; mobility, and lifting and handling needs; sensory awareness; communication; literacy, social skills; likes and dislikes; and any difficult behaviour patterns or safety issues. Daily routines are noted in order to ensure that ongoing commitments are maintained such as attendance at college and day centre activities. Individual assessments clarify if any specific equipment is needed. For example in respect of a Service User who has a tendency to develop pressure sores. When the Service User has respite care, an alternating pressure-relief mattress is obtained and fitted to the bed prior to admission. The Manager arranges for Service Users with high physical needs to be admitted to the ground floor, where the communal bathroom and all bedrooms have overhead tracking fitted for hoisting facilities. The Inspector noted that the manager had specifically requested in writing that a service user, known to have severe mobility difficulties, be reassessed and appropriate training provided to all the care staff who would be involved in moving and handling the service user prior to any planned admission and that the request was responded to promptly by the Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 13 Physiotherapist, from the CLDT. The manager stated that had this request not been responded to, then the service user would not be admitted for respite care until such time as it was possible. It is essential that the manager and staff continue to be assertive in respect of any referrals made and refuse admission unless confident that an individual’s needs can be met. Assessments also consider the compatibility of Service Users for staying with others, and this is taken into account with the allocation of rooms. The Manager operates the bookings on a flexible system; however this is predetermined in terms of overall allocation by the local CLDT team and is currently under review as stated in Standard 2 in order that the allocation is shared on a more equitable basis amongst those who are eligible to use the service. It is crucial that Kemsing Road staff members are enabled to plan specific admissions in advance to ensure the compatibility of service users at any one time. The manager was advised to inform CSCI in writing should there be any difficulties arising from the allocation of individual care episodes determined by CLDT in their current review. See Standard 10. See Requirement 5 In general terms it was noted that a previous requirement to ensure that all care plans are updated was not fully complied with owing to a reported difficulty in arranging a backlog of reviews with CLDT. The Inspector was advised, as already stated in Standard 2, that all care files would be updated by the end of February 2007 and in view of this a new restated requirement has been made to ensure that this is complied with and that the manager is also required to report any default on this timescale to CSCI in writing prior to this date. As only three care files have been fully updated so far, a considerable number still have to be updated and therefore the home did not meet this Standard. See Requirement 2 Standard 7 Interaction between staff and service users, observed by the Inspector, demonstrated choice being encouraged by staff members in relation to activities taking place and choice of food provided. The level of disability and communication difficulty of service users is such that staff members could not meaningfully engage service users in participating in the running of the home and contribute to policies and procedures, nor is this appropriate for a respite care service. On a daily basis, however, staff members do make attempts to involve service users in household chores and a specific page has been included within the Individual Support Requirements document that clarifies what involvement is acceptable to the service user and how this should be implemented by staff members. Enabling service users to express their choice in relation to outings, meals and activities is promoted by showing pictures and direct reference to specific items Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 14 and the historical knowledge built up by staff members about individuals recorded in their care files. Some staff members have received training in communicating with those with communication difficulties, for example, using Makaton. A communication profile is also provided for each service user and located under section 3 in the new care file that guides staff members as to how to interpret and respond to the individual’s communication needs. It is recommended, nevertheless, that all staff receive appropriate training in dealing with those with communication difficulties. See Recommendation 2 Both the Service user Guide and complaints procedure have been produced in a picture form to facilitate appropriate communication. This is commendable. Evidence was available from the service users’ records examined that they are enabled to express choice in what they do but staff members must remember to record these occasions in order to demonstrate their efforts in this respect. See Recommendation 3 Standard 9 Risks are being assessed, prior to admission to the home, and action taken to minimise any risks and hazards as stated in the example in Standard 6. The manager acknowledged that there had been shortfalls in the past and that whilst risk assessments are available in all service users’ care files these are being updated, following the programme of updating community care assessments but it is vital that the home seeks clarification from carers prior to current admissions of any service user with any changed needs or functioning since the previous admission of the service user. The facility for doing this exists and staff members are required to contact carers and receive written confirmation from them, prior to admission in respect of any changed needs. Current risk assessments are now located under Section 4 of the care file as one of the specific “Individual Support Requirements.” See Requirement 4 Any restrictions placed are few and would be for the safety and welfare of service users, for example not leaving the home unaccompanied or not being involved in certain activities that would be individually risk assessed and recorded in the Current File. The home has a missing persons procedure and up to date photographs provided on care files to assist in such an eventuality. Standard 10 It is crucial that Kemsing Road staff members are enabled to plan specific admissions in advance to ensure the compatibility of service users at any one time. The manager was advised to inform CSCI in writing should there be any difficulties arising from the allocation of individual care episodes determined by CLDT in their current review. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 15 See Requirement 5 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 16 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): 12-17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention was given to meeting the leisure and social needs of the residents but staffing should be reviewed to assess whether the input required can be adequately met with existing staffing levels and because very few staff members can drive the mini bus. Meals provided were varied and planned to meet the resident’s choice and preferences. EVIDENCE: Standards 11 & 12 These Standards were not assessed because they are not relevant to a respite care service. However, within the context of Standard 12.2 service users are encouraged to take part in activities engaged in prior to entering the home wherever this is possible. Standards 13 & 14 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 17 A weekly Planner has recently been produced that is required to be completed prior to the service users’ arrival based upon the latest care information available. The second page of the document also serves as a communication both to and from carers and staff about updated information and the first page is copied to carers so they have a record of the activities provided. This is a very good initiative, but only just introduced so it was not possible to assess how effective a monitoring tool of the level of activities provided this proves to be. Activities were evidenced in the daily diaries, and within tasks for staff listed in the shift planners. However, from the recorded information seen and interviews with several staff members it was clear that the provision of outings and activities is severely hampered by a lack of staff members who could drive the mini bus. See Requirement 6 & Recommendation 4 Enabling service users to express their choice in relation to outings, menus and meals and activities are promoted by showing pictures from a recently, compiled activities folder, and direct reference to specific items and also the historical knowledge that has been built up by staff members about individuals recorded in their care files. Standard 15 Through the various activities and outings provided residents are provided with some opportunity for meeting with other people; however, staff report that they have not experienced any significant relationships for any of the residents within the home, owing to the transitory nature of the service. Any public expression of a sexual nature from a service user would be responded to so as to ensure that the dignity and respect of all service users was maintained and the person concerned encouraged regarding privacy within their own room. Family members and friends are able to visit at any time, and staff members encourage service users to maintain friendships. Respite care may be planned because the next of kin are on holiday, and therefore attention to facilitating supportive relationships and friendships may well be of greater significance Standard 16 Residents were enabled to choose what clothes to wear and hairstyles, and when accompanied by staff members on shopping trips to make choices for themselves in their purchases. Staff members enable service users to choose whether to join in with activities if they wish, stay in their own rooms, or go on outings, having been risk assessed prior to whatever activity has been chosen. It was noted that individual rooms cannot be personalised but nevertheless, some of the pictures provided were not the most appropriate for service users and it is recommended that this is reviewed along with others in corridors and communal Areas to provide subjects that might interest or stimulate those with learning difficulties. See Recommendation 5 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 18 Standard 17 Varied and nutritious meals were provided to meet resident preferences and a rota of meals provided was seen over a period of four weeks and a good supply of both fresh and frozen food was seen stored in the home. Service users require a variety of special diets and evidence was seen that these are recorded on individual care files and information provided in the kitchen area to alert staff to any special requirements currently. Several service users require physical assistance from staff members and a range of special implements are used both to eat safely and ensure adequate intake. Staff members were observed assisting service users in a discreet way on one of the days of inspection. The care files seen contained detailed information about maintaining nutritional needs, taking into account different food preferences, and specific diets. Menus are planned weekly, according to the different Service Users coming into the Home for the next week. A set meal is prepared each evening, and a list of alternate choices is kept available (e.g. for soup, sandwiches, jacket potatoes etc.). The Inspector viewed the kitchen on both floors. Both kitchens were clean, hygienic, and well equipped. There was suitable food stored in the cupboards, and items in the fridge were labelled and dated. Fridge and freezer temperatures are recorded every day. Fresh fruit and vegetables are used as much as possible. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs were being met based on assessment of need and with the involvement of the resident. Medicines were safely managed. EVIDENCE: Standard 18 The two new updated care plans examined showed that systems are in place to identify the personal support required by each Service User, and clear instructions are written to enable support staff to know individual needs. Personal care is provided in the privacy of the Service User’s own room and en-suite facility, or in the bathroom on their particular unit floor. However it was noted that privacy could be compromised in some service user bedrooms because curtains holding mechanisms were collapsing and the bathroom door on the ground floor was ill fitting in relation to adjoining panel. See Standards 25 - 29 and Requirements 15 & 17.These rooms have been set up with the necessary equipment, and service users are supported or supervised according Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 20 to their individual ability. However the overhead lighting must be improved. See Requirement 16. Same gender care is always given to female residents and where possible to males, and this is discussed and agreed during the pre-admission assessment stage. Service Users are assisted with going to bed and getting up at their preferred times, as much as possible, but there is an understanding that the Home has to operate a tight schedule in the mornings, to ensure that service users are ready for their transport to college or Day Centre, and have had their personal items, clothing and medication checked out if they are returning to their own homes that day. Standard 19 There are established systems of liaison between different health professionals, ensuring continuity of care. These include medical and psychiatric consultants, District Nurses, dietician, physiotherapist, GPs, occupational therapists and speech therapists. Initial Occupational / Physiotherapy assessments, prior, to the first admission to the home, are carried out, when required, checking for use of wheelchair, use of bath or shower, and vehicle use and subsequently following any changes in need being reported. Personal support plans show detailed instructions, for example, for maintaining pressure relief and prevention of pressure sores; moving and handling instructions; detailed skin care; continence care and mouth and dental care. Charts are used to record weight, bowel care and fluid/nutrition intake if needed. Those records that were examined were comprehensively completed. Standard 20 All staff members are required to carry out basic medication training as part of their induction; however, medication is only administered by the Team Leader on duty at the time, as they have received additional training and a written assessment. A staff member who is nurse trained oversees training and assessment and all team leaders have received updated training in the use of the new protocol and MAR sheets. Medication is stored in lockable medicine cupboards located on each of the two units. Medication cupboards were well organised, and each Service User’s medication was stored separately. Medication Administration Records (MAR charts) had been redesigned, and those examined were properly completed and signed. The new form had been designed specifically to cater for the particular needs of Kemsing Rd and incorporates sections to record medication received on admission and at discharge with signatures and also for any sent to a day centre signed either by the driver or the escort. Each Service User has a separate medication folder, which has their photograph, and their room number entered on to it. There are specific guidelines for each Service User for Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 21 administering their medication. Medication is given to each Service User one at a time, in case there is a distraction or an emergency situation at the same time with other Service Users. The manager reported that there is a potential for service users needing peg feeding to be admitted to the home and as staff members are not currently able to manage the care for Service Users with Peg feeds, they will require specific training in this aspect of care and have a certificate provided by the nurse trainer to evidence this prior to any such admissions. This training must be updated annually. Service Users with epilepsy have a detailed, laminated sheet in their medication folder explaining how a seizure is recognised for that person, and how to deal with it (i.e. this includes the triggers, signs, pattern and other information. Both this and the administration of rectal diazepam must also be subject to the annual updating / training of staff members and evidence provided that this has occurred. See Requirement 7 It was noted that since the dismissal of two night-time care staff the care workers currently on night duty had not received training in the administration of PRN medication. In order to cover this eventuality the Inspector made an immediate requirement that all night- time care staff must receive this training and be assessed within a week and that arrangements were made to provide immediate on call cover in the meantime. See Immediate Requirement 8 The Manager stated that random audits of medication are conducted on a regular basis (e.g. once/twice per week.) Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Adequate procedures were in place to ensure complaints were appropriately managed. Good efforts have been made to address a number of recommendations made following the CLDT investigation report on the home. Those remaining must be attended to as soon as possible and new systems, recording requirements and improved communication between staff members maintained in order to achieve compliance with Standard 23. EVIDENCE: Standard 22 The home had policies and procedures in relation to complaint management. An adequate system was in place to record complaints made about the service. A pictorial complaints leaflet has been provided to assist residents understand the facility and a book provided in the entrance area for the purpose of encouraging visitors to the home to register any concerns or compliments in writing. The Inspector examined the complaints log and noted that since the previous inspection in May 2006 there had been three relatively minor complaints that had been dealt with appropriately by the home. Regrettably there have also been complaints in respect of five adult protection incidents referred to in the following Standard. Standard 23 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 23 Five incidents of an adult protection nature have arisen, one just prior to the previous inspection, that could not be reported upon in the last report as the investigation had only just commenced, and four subsequent to the inspection. The first incident related to a service user who suffered fractures to a leg; these injuries were fully investigated under the London Borough of Greenwich Adult Protection procedures. However, the outcome in respect of how and where precisely the injuries occurred was inconclusive. The second incident also related to a fracture of the leg and whilst the outcome was not entirely conclusive the injury was considered to have most likely occurred during an episode of moving and handling within the home. The investigation report subsequently made a series of recommendations to be implemented by the staff of the home. The most significant of these was the finding that there was variable understanding and knowledge of the moving and handling requirements of this service user by the care workers involved at the time. The third incident involved an allegation made by one care worker that another had restrained a service user. The investigators found no conclusive evidence that the event had taken place but questioned the alleged perpetrators professional credibility and integrity. These matters are being dealt with via disciplinary proceedings, as recommended, within the investigation report. The fourth incident involved a care worker making an allegation that another care worker had assaulted a service user. There was no substantiating evidence to be found in relation to this. However, the investigators did uncover inconsistencies of practice and concerns regarding the competence of both the alleged perpetrator and the whistle blower. These matters are being dealt with via disciplinary proceedings, as recommended in the investigation report. The fifth incident related to a service user sustaining a small bruise to the side of her face. The conclusion of the investigators was that this was most likely caused by self-injurious behaviour. Subsequent to the above investigations, three further incidents have been investigated separately. Firstly a service user was found to have bruising on his back. However, the conclusion was that this was consistent with a fall suffered the previous day. The second incident related to a service user ingesting pieces of puzzle following them being spilt on the floor. Two members of staff picked up the pieces immediately but had not noticed missing pieces already in the service user’s mouth. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 24 The third incident related to an unannounced night visit by the manager, when two members of waking night staff were found to be asleep on duty and suspended from duty immediately and subsequently dismissed. The number of Adult Protection issues arising within the home resulted in an investigation by the London Borough Of Greenwich Community Learning Disability Team and a substantial number of recommendations have arisen from the report subsequently produced. The recommendations were wide ranging but those relevant to this Standard are as follows: Adult protection training must be provided for all staff members. This was done. Greater clarity and recording at handover sessions. New and more comprehensive hand over sheets developed and now being used and the time for handovers increased. Any new staff members not familiar with service users accommodated have extended time prior to handovers to familiarise themselves with the care files and Team Leaders required to check that significant issues have been understood adequately by all incoming staff on duty. New staff members are also required to have induction training and this recorded by senior staff on duty. The reporting of incidents procedure including Regulation 37 notifications to CSCI to be improved, that is, sent within 24 hours and sufficient detail provided to enable a judgement to be made as to the seriousness of the incident, this is improving but staff still have an outstanding training requirement in this area. See Requirement 9 The Whistle blowing procedure was to be rewritten and all staff must sign that they have read and understood the policy; training to be provided in this area. The policy has been provided and staff members have read the document but they must all sign it and training must be provided as soon as possible. See Requirement 10 Positive steps had been taken by management in the areas of increasing supervision, team meetings, updating of care files and risk assessments (ongoing), ensuring reasonable hours being worked by staff members and defining the role of one to one support. The Inspector noted that in response to a request for respite care for a service user, known to have significant moving and handling difficulties, training from an OT was requested in writing prior to any commitment being given that the service user could be accommodated. The manager stated that in all similar situations this would be requested for all staff who would work with the individual and that the service would not be provided unless this was the case. Overall, whilst this Standard was not met, it was evident that improvements have taken place in response to the recommendations of the CLDT report and that attention to those still outstanding, should mean that the required Standard can be achieved. All staff members interviewed described a period of Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 25 low morale around the time of the investigation but that there was now a feeling that the improved structure of communication, record keeping and staff training and supervision were gradually paying off in terms of the service provided and that morale was improving. The service users using this home are amongst the most challenging in respect of their physical frailty and level of communication difficulties and the staff members are required to continually adapt to the constant change of clientele accommodated at any one time. The Inspector felt that staff members were making good efforts and were motivated to provide a good service for the benefit of service users. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 26 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a homely and comfortable environment that is safe clean and hygienic, but attention must be paid to a number of items that were identified as in need of repair or replacement. The premises were homely in appearance but generally in need of redecoration. Individual and communal accommodation mostly suited residents’ needs but some areas were identified for improvement and two need to be attended to urgently to promote the privacy of service users. The Service had the specialist equipment they need to maximise their independence. The home was clean and hygienic. EVIDENCE: Standard 24 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 27 Access to the property, can only be gained by a member of staff opening the front door from the inside, and there are security keypad locks in place on each floor to prevent service users from leaving the building unaccompanied. The Home was purpose built, and consideration has been given to ensuring suitably wide corridors for wheelchair users, and access to all floors via a passenger lift. However, it was noted on the ground floor unit that mobility aids were stored in an alcove, accessible to service users; this should have some form of concertina or foldable door fitted to prevent such access by service users and possible injury. See Requirement 11 A special recliner chair and a sofa are in a poor condition on the ground floor unit; the recliner chair needs adequate repair or replacement and the sofa must be replaced. See Requirement 12 The dishwasher on the ground floor unit had not been working for over five months and must be replaced to allow care staff to concentrate on their care responsibilities. See Requirement 13 Staff rooms, and laundry facilities are situated on the top (second) floor, and this is not ideal as staff members have to leave service users every time they need to carry out laundry care. Medication management has, finally, been improved by the installation of medication cabinets on each floor in a response to a longstanding requirement. The relocation of current service user files in the lockable cupboards that house the new medicine cabinets is an improvement. However, the storage of service user records in these cupboards is inappropriate and purpose built lockable cabinets must be provided on each unit to house them properly. See Requirement 3 Overall, the standard of decoration was adequate but could be much improved by redecoration of the walls on both units and adjoining corridors. See Recommendation 6 Standards 25 - 29 Individual bedrooms are suitably sized for special equipment. Ground floor bedrooms are fitted with overhead hoisting facilities, and all bedrooms have en-suite toilets and showers. These were fitted with grab rails, handrails, specialised toilet seats and other equipment as needed. All rooms are fitted with a call bell system. Bedrooms were fitted with good quality furniture and furnishings, but looked rather bare as there is not the opportunity for service users to personalise rooms. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 28 The system for supporting the curtains throughout the building must be addressed, but particularly in service users’ bedrooms as privacy is currently being compromised. See Requirement 14 It was also noted that the economy lighting installed in bedrooms gives a very poor light. It is essential that care workers have sufficient lighting when performing delicate moving and handling operations and attending to the personal care of service users who have substantial physical disabilities and/or challenging behaviour. This matter must be addressed as soon as possible. See Requirement 15 The bathrooms on each floor are fitted with specialist baths, enabling service users to have a bath, instead of a shower within their en suite rooms if they prefer. Risk assessments are carried out to specify the level of supervision needed for someone having a bath. The Inspector noted that the bathroom door and adjacent side panel had a large gap between them that meant that privacy for service users was compromised. This must be attended to as a matter of priority. See Requirement 16 Each flat has a lounge leading through to a dining area, and a separate kitchen. The communal lounge/diners do not allow much space if the home is full and service users choose to use the communal accommodation. This is especially difficult if there are a number of wheelchair users in residence, or if any service users are exhibiting challenging behaviour. In order to maximise adequate supervision of service users (and the ability to respond to any potential emergencies), it is particularly important that the service has the ability to control the allocation of service users using the service at any one time, to ensure that a cohesive mix is present. There is no sensory room or quiet area, and the Inspector noted that some portable sensory equipment, to provide flexibility of use, has now been provided for the use of service users. This provision was a recommendation at the previous inspection and has been responded to positively. Consideration should be given to provide further items of sensory equipment. See Recommendation 7 The garden area could be improved by the provision of a hard surface/ pavement to access the flower border and also the removal of some shrubs to allow service users to access the raised flower- bed to one side of the garden. Both initiatives might further the limited sensory facilities the home has available for service users. See Recommendation 8 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 29 Standard 30 The laundry room is fitted with 2 washing machines and 2 tumble dryers. However it was noted that these machines are of domestic quality and a red alginate bag system is used for dealing with soiled items. The demands on the service with such a high turn over of service users requires industrial quality machines with an integral sluicing facility. See Requirement 17 Each service user’s laundry is washed separately. The Home was very clean, throughout the building. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 30 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The Training Action Plan needs to be fully implemented. The recruitment policy and practices was satisfactory. Regular supervision of staff must be a priority as well as training for all staff that perform that task. EVIDENCE: Standard 32 The Manager is currently well supported by one deputy manager who works part time three days per week. However, another full time deputy post is currently vacant following the resignation of the previous deputy. The Inspector was informed that a person has been appointed subject to CRB clearance, who it is anticipated will commence duties by the end of December 2006. It is very important that this person is appointed as a priority in order that the manager can be supported to fully implement the recommendations following the outcomes of the investigation of the home. The Inspector should be informed should this appointment not take place by the timescale envisaged. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 31 See Recommendation 9 Several staff had completed NVQ 2 or 3 training; however the company will need to carefully monitor that the required 50 of staff qualified to NVQ level 2 is maintained. The four staff members interviewed on the days of inspection had a good understanding of the Service Users’ support needs, and worked well together to provide effective care. Please see Standard 35 re training needs. Standard 33 Staffing levels are satisfactory but this will require continued monitoring to ensure that at times when challenging behaviour is presented adequate supervision is provided. The current deputy manager post must be filled as soon as possible as noted in Standard 32. The existing vacant hours for care workers should be filled as soon as possible in order to allow flexibility of manning the rota via permanent staff in order to facilitate consistent provision for service users from staff members who are well acquainted with the needs of service users. See Recommendation10 Standard 34 The Inspector examined three staff files at this visit. Documentation was seen that showed that application forms include a section for previous employment history, with an explanation required for any gaps in employment. 2 written references are taken, and POVA First checks and CRB (Criminal Record Bureau) checks are carried out prior to commencement of employment. The CRB checks are arranged through the Company’s Head Office, and the Manager sees written confirmation of the CRB, and the information included. Standard 35 The Company have their own comprehensive training programmes for all staff, which includes all mandatory training (fire awareness, moving and handling, basic food hygiene, first aid and infection control), and other relevant courses. Additional training is given in understanding autism, sign-along (communication skills), medication training, and behaviour management (nonviolent crisis intervention). However, there is a considerable amount of training required arising from the CLDT investigation. The management response to this must be implemented in full, as soon as practicable. See Requirement 18 Standard 36 Supervision has lapsed since the previous inspection in May 2006, although recent records showed an improvement and the manager stated that the aim was to achieve monthly supervision sessions. Formal supervision must be Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 32 conducted at least six times per year and all supervisors must be provided with a supervision skills course as soon as possible. See Requirement 19 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 33 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 judgement has been made using available evidence including a visit to this service. Following a difficult period the manager has introduced new systems to improve record keeping and communication between staff in response to the CLDT investigation recommendations. The appointment of a Deputy manager is required to assist the manager further in this process. The annual survey conducted by Caretech of views on how the home is run must be available for inspection and retained within the home and a copy forwarded to CSCI. The Health and Safety of service users are promoted and protected. EVIDENCE: Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 34 Standard 37 The Manager joined the staff group in February 2006 and is experienced and qualified to run the home. He is currently undertaking the Registered Managers qualification and hopes to have completed this by the middle of 2007. The manager hopes to be appointed as the Registered Manager for the home and will be submitting his application to the CSCI in the near future. Positive feedback was received from four staff members interviewed that the manager is approachable and that following the CLDT investigation improved procedures are being adopted in the running of the home. The manager must now apply to become the registered manager as soon as practicable. See Requirement 20 Standard 39 The Home provides feedback questionnaires for service users and relatives to complete after each visit, these showed that service users are generally happy with their levels of care, and have the opportunity to raise concerns in a nonthreatening environment. However, the annual survey conducted by Caretech must be available for inspection and retained within the home and a copy forwarded to CSCI. See Requirement 21 Standard 42 Staff members were trained in safe working practices and this was substantiated when interviewing four staff members and through observations made by the Inspector. Chemicals for cleaning and laundry were kept in locked cupboards, and COSHH leaflets were available. Storage for wheelchairs and hoists was limited and a requirement made (please see Standard 24). A monthly health and safety check is carried out for the building and was seen by the Inspector. Several other records to do with Health and Safety were examined and checked against the pre inspection questionnaire submitted at the previous inspection. Those checked were comprehensive and up to date. Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 35 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 1 3 X 4 X 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 1 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 N/A 12 N/A 13 2 14 1 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 N/A 2 X 2 X X 3 X Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 36 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 YA1 Regulation 4 & 6 and Schedule 2 15 (2) Requirement To ensure that the Statement of Purpose and Service User Guide are updated as soon as possible and include the qualifications of staff employed. To ensure that all assessments care plans and care files are brought up to date in respect of the needs of service users. Restated Requirement, previous time scales of 31/12/05 and 31/08/06 not met The Registered Person must ensure that arrangements for the allocation of respite care is firmly based upon whether the home can adequately meet both the individual and collective needs of the service users accommodated at any one time. Should this ever not be the case, then, the relevant individual admissions must be refused and reported to CSCI & CLDT immediately, prior to any such admission, taking place. The Registered Person must ensure that updated risk DS0000062951.V311416.R01.S.doc Timescale for action 01/03/07 2. YA6 01/03/07 3 YA6 12 01/03/07 4 YA9 14 01/02/07 Kemsing Road Respite Service Version 5.2 Page 37 5 YA10 17 6 YA14 16 m & n 7. YA20 13 assessments are in place and signed by carers prior to the admission of all service users to the home. Lockable cabinets must be provided on each unit to store confidential care files and service user records appropriately. The Registered Person must review & assess the adequacy of activities and outings provided for service users. The administration of Rectal Diazepam and Enteral feeds must be subject to annual training updates by qualified nursing staff and certificates of training provided. Current waking night staff must receive training and be assessed as competent to administer PRN medication in an emergency within a week from 22/11/06. In the meantime, a member of staff must be available on call to respond to any such emergencies arising. The Inspector was informed that the above was complied with. The Registered Person must ensure that all staff members are aware of requirement to inform the CSCI of all significant events both to service users and within the home, within 24 hours in writing. Notifications must be appropriately detailed to allow judgements on any future action required. Those circumstances that require notification to the CLDT must also be made known to staff members. The Registered Person must ensure that all staff members personally sign, an appropriate document to confirm that they DS0000062951.V311416.R01.S.doc 01/03/07 01/03/07 01/03/07 8. YA20 13 22/11/06 9 YA23 37 01/01/07 10 YA23 13 (2) 01/02/07 Kemsing Road Respite Service Version 5.2 Page 38 11 YA24 13 (4) c 12 YA24 23 13 14 YA24 YA26 23 (2)c 12 (4) a 16 c 15 YA26 13 (5) 23 p 16 YA26 12 (4) a 17 YA30 23 (2) k 18 YA35 18 (1) i 19 YA36 18 (2) 20 YA37 9 have read and understood the newly produced Whistle Blowing Procedure. The alcove on the ground floor unit housing mobility aids must be made safe by the provision of a foldable door. The recliner chair on the ground floor unit must be repaired /replaced as a matter of priority and the sofa must be replaced. The dishwasher on the ground floor unit must be replaced as a matter of priority. Curtains in service users’ bedrooms must be secured as a matter of priority to afford privacy. Others in other areas must be secured as soon as possible. Adequate lighting must be provided in service users’ bedrooms in order not to compromise safety in moving and handling. This must be rectified urgently. The gap between the door and side panel of the bathroom door on the ground floor must be concealed as a matter of urgency to promote adequate privacy for service users. The two washing machines must be replaced with industrial quality machines with a sluicing facility because of the extensive usage in this respite care home. The training listed in the document Staff Training Action Plan must all be implemented as soon as possible. All staff members must receive a minimum of six formal supervision sessions per year and all supervisors must receive training in supervision skills. The Registered Person must ensure the manager submits a DS0000062951.V311416.R01.S.doc 01/03/07 01/03/07 01/02/07 01/02/07 01/01/07 01/01/07 01/04/07 01/04/07 01/03/07 01/03/07 Page 39 Kemsing Road Respite Service Version 5.2 21 YA39 24 completed application to register with the Commission as soon as possible. Surveys of the views of relatives, 01/03/07 friends, advocates and involved professionals, in respect of the home, must be conducted and a copy retained in the home and sent to CSCI. 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 Refer to Standard YA1 YA7 YA7 Good Practice Recommendations The mission statement recently produced could usefully be included in the Statement of purpose and Service user Guide. All staff should receive ongoing training in relation to communication needs of service users. Staff members should remember to record in the daily diaries of service users when service users have been offered or indicated their own personal choice in situations. The Registered Person should seriously consider appointing a part time driver for the mini bus to ensure that service users are provided with an adequate level of activities and outings. The provision of more suitable pictures for the home that service users could relate to should be considered. The home would benefit from redecoration of the walls throughout the building. Service user could benefit from the provision of more items of sensory equipment. Service users would benefit from the provision of a pathway to the flower area and adapting the raised bed to the side of the garden to provide tactile/ sensory experience. It is recommended that the manager inform CSCI should there be any delay in the appointment of the deputy manager. Existing vacant hours should be filled with permanent staff members to facilitate consistency with service users. DS0000062951.V311416.R01.S.doc Version 5.2 Page 40 YA14 5 6 7. 8 YA16 YA24 YA29 YA29 9. 10 YA32 YA33 Kemsing Road Respite Service 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 Kemsing Road Respite Service DS0000062951.V311416.R01.S.doc Version 5.2 Page 41 - 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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