Inspection on 06/12/05 for Ledgers Bungalow

This inspection was carried out on 6th December 2005.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ledgers Bungalow 18/10/06

Ledgers Bungalow 21/06/05

Ledgers Bungalow 02/02/05

Ledgers Bungalow 08/07/04

Ledgers Bungalow 24/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Ledgers Bungalow Queen Street Paddock Wood Tonbridge Kent TN12 6NP Lead Inspector Lynnette Gajjar Unannounced Inspection 6th December 2005 10:15 Ledgers Bungalow DS0000024043.V269912.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 Ledgers Bungalow DS0000024043.V269912.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. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ledgers Bungalow Address Queen Street Paddock Wood Tonbridge Kent TN12 6NP 01622 769114 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) ledgers@MCCH.org.uk MCCH Society Limited Mrs Jennifer Mary Parrott Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Some Service Users may also have a Physical Disability. Date of last inspection 21st June 2005 Brief Description of the Service: Ledgers Bungalow is one of a number of registered care homes managed by MCCH Society Ltd in the south east of England. The home offers 24-hour care to 5 residents with a learning disability, who may also have a physical disability. Ledgers Bungalow is registered for 6 people; there are currently 5 residents with the 6th small bedroom being used as the homes office. All residents have single rooms. The home comprises of an assisted bathroom and shower room, separate disable accessible WC, kitchen /dining room, and lounge. There is a small laundry facility. Ramps are fitted to external doors to allow access to the large garden and pond. There is a large drive-offering car parking for approximately 5 cars and the homes minibus. The bungalow is situated in a small hamlet off Queens Street, approximately 2 miles from Paddock Wood. Paddock Wood has a main line station and bus services. Paddock Wood is a small town offering all local shops and amenities i.e. library, supermarket, various shops, hairdressers, opticians, dentists, GP and banking services etc. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 10:00am until 15.15pm. The home has 5 people in residence who have lived together for a number of years. The visit was spent talking directly with three residents at the home privately and collectively, with staff interpretation through their individual communication methods; four care workers, the senior carer, the manager and two relatives who visited during the day. Two residents were out at day services with supporting staff. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the resident in the report. Some judgements about quality of life and choices were taken from direct conversation and physical responses with people living in the home as well as direct observation followed by discussion with staff and relatives, evidencing records and care plans held at the home. A tour of the house was undertaken. What the service does well: What has improved since the last inspection? Resident’s personal care has been enhanced with the additional equipment assessed for individuals and ensures safety for both residents and staff. Staff are benefiting from a new system of formalised supervision with their line manager that is recorded and monitored. The manager and staff have commenced fundraising to purchase a new adapted vehicle for use by residents. Successfully securing a large donation Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 6 from a voluntary source. This will enable better and more flexible access to the community and less dependency on taxis. Residents are benefiting from staff continuing their knowledge and skills through ongoing training in health and safety core training. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ledgers Bungalow DS0000024043.V269912.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 Ledgers Bungalow DS0000024043.V269912.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): 1,2 Residents and representatives looking at Ledgers Bungalow are given all the information that they need to be able to make an informed decision to live there. EVIDENCE: The homes statement of purpose and residents guide continues to be reviewed to use more pictorial / photographic / object referencing. This will enable resident’s easier access and clear understanding of what services the home provides who have limited reading skills. No further progress has been made since the last inspection in June 2005. The key working and person centre planning process is developing slowly to offer clear promotion and support in identifying personal aspirations and meeting individual care needs. A care plan viewed showed person centred approaches, with personal aspirations and goals discussed, including, where they would like to like to live, experiencing various exotic holidays and activities, i.e. travelling to India and riding an Elephant, to visiting local wild life safari parks and adopting an animal. Others aspirations reflected their interests and personalities also. The current residents living in the home have lived here for many years. The home has not had any new admissions, although the organisation has full procedures and assessments to follow in the event of a vacancy occurring. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 9 Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Care plans continue to develop to hold information and guidelines to ensure that residents receive individual care. Through better systems of filing and recording formats, residents will be ensured consistent and effective monitoring of their care. EVIDENCE: Care plan records seen today are in need of a tidy up by staff. Papers were not securely fastened in, muddled, in order of reference and difficult to track, with information that had been superseded by new guidelines or risk assessments in places. Development of a formal behaviour management record would assist in monitoring and reviewing current behaviours being experienced with staff and the challenging behaviour specialist. Information on care requirements is available but took time to find and eliminate nonrelevant documents. By moving basic information, risk assessment and care guidelines to the front or separate file will make easier for staff to access and follow. Regular formal reviews are taking place with records kept. Records and discussion with residents and staff confirmed regular contact with the GP, chiropodists, opticians and consultant appointments, sometimes with relatives taking them or staff from the home. Records are stored securely. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 11 Interaction between residents and staff is good showing genuine respect and appropriate familiarity with each other. One resident has a good understanding of their care plan, documentation held within it and records maintained, sitting with the inspector and discussing the content openly and with familiarity. This resident currently is the only one who has the ability to fully understand the care planning process and expresses any interest in it. Others are heavily reliant of their relative’s advocates support and understanding to sign on their behalf. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 Residents are given encouragement and support to make choices about aspects of their daily lives, including a range of local social and recreational interests. Menus provide wholesome and nutritious food. EVIDENCE: Continued support from staff enables individuals to access Paddock Wood amenities and the local area including shopping, walks in the park, trips to the coast, garden centres, meals out, concerts, local authority and charitable day centres. Due to the remote location of the home all amenities have to be accessed by transport. Hair appointment was made during this visit and on discussion residents detailed many social activities from Party in the Park over the summer to drives out and recent bonfire and firework party at the home with family and friends. Residents continue to access specialist day services such as Tunbridge Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 13 Wells Day Service and satellite unit at Paddock Wood, Scotts Project, Hydrotherapy at Sevenoaks and Burrswood, Aromatherapy sessions Resident’s families are in regular contact, with an open door visiting policy. With weekly visits to the home, their relatives home and social activities. When discussed with residents: “I see mum and dad every Tuesday and Thursday and they take me to my Nan or shopping, I am going there today. I also ring my brother sometimes too.” “I am going to my Nan for Christmas” “Did I tell you I am going on holiday next week too to Church town in Cornwall I can’t wait”. When talking to another resident with limited communication, whether they were still meeting Mum and she also visiting, they gave a big smile, engaging eye contact, moving hands up to face in excitement and happy vocal sounds to indicate they did. Staff and records also indicated regular and two way contact with relatives and residents. Due to personal preferences some residents have chosen not to have holidays away from home but days out. The kitchen was observed to be clean although still awaiting refurbishment to make it more resident accessible and address cracked tiling and units to manage good food hygiene standards. The manager stated Kelsey Housing Association had agreed to replace work surfaces and units but no start or completion date has been set. A number of cracked tiles have increased since the last inspection. A new freezer was to be delivered this week. The kitchen was stocked with fresh produce and meals were served with ample portions. Support and guidance has been made regarding diet management for residents particularly where subsidised meals are prescribed to monitor and ensure meeting dietary needs. Adapted cutlery and crockery is available for those requiring such assistance. Residents receive full staff support at mealtimes. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The health, social and personal care needs of residents are well supported with regular contact with specialists and external professionals. Residents are treated with genuine respect and dignity by care staff. EVIDENCE: Through discussion with a staff and records viewed, it is clear that residents are given full support and encouragement to maintain personal contact with practices nurses, GP, community learning disability staff, challenging behaviour specialist, mobility advisors and consultants, as well as chiropodist and dentists, to maintain good standards of health and well being. Staff spoken with today evidenced they were aware, of the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Ongoing support is received from the challenging behaviour specialist. Better record keeping systems will aid monitoring and tracking of behaviours experienced. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 15 Safe and secure systems are in place with regards the storage and administration of medicines. Only staff who are trained administer medication. MAR sheets seen were detailed, one was becoming more difficult to read due to additions received this week and limited space to fill on the current chart. Medication was being administered as direct by GP. Minor recommendations were made to improve current practice in record keeping and guidelines. See recommendations at the end of the report. . Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Systems are in place to enable those living and those visiting the home to raise concerns or complaints with staff. Protection from abuse is promoted through staff training and understanding of actions they may need to take EVIDENCE: Copies of the complaint procedure are available in the home. Due to the nature of the service and those resident living here, using this system is very limited. It was evident a resident was clear about whom they would talk to if they were unhappy about something and had done this in the past. Others would require relative/ advocate to identify concerns and raise them on their behalf. Advocacy for residents has been transferred to referral list for emergencies through West Kent Advocacy Scheme. Staff who were spoken with showed a good understanding of how to protect and prevent abuse, including reporting under local procedures. There are no current adult protection alerts relating to this home. Issues of restraint have been address particularly for the use of bedsides and wheelchair lap-straps. Behaviour guidelines are set through multi-disciplinary meetings and are proactive in positive responses and intervention for the individuals. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30 Residents live in a comfortable and clean home. Safety will be enhanced further following completion of the refurbishment of the kitchen and dining area. Bathrooms will offer much safer facilities on receipt of the assessed shower chair, and the completion of subsidence and underpinning work urgently required. EVIDENCE: The home continues to be presented to good standard of hygiene and cleanliness. Visits have occurred to the homes and Kelsey housing have agreed to refurbish the kitchen / dining area to be make easier, safe access and use by residents to make their own drinks and snacks where possible. Cracking of tiles and broken units compromise good food hygiene standards and basic infection control management. The subsidence has also been reassessed and work has been agreed however a start date has not been set. Also due to the work residents will need to move out for approximately 6 weeks. The manager has no indication of when Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 18 this will take place. It was noted that large cracking in the bathroom floor had been sealed by hazard tape. This was worn and not promoting effective infection control but also of concern for tripping and catching of wheelchairs and hoists. An incident was recorded last month where a resident slipped from sling in hoist whilst being transferred over this crack. This bathroom does not have any natural light or ventilation. Further cracking has occurred since the redecoration in the hallway. All rooms are single, individually decorated, furnished. All have specialist equipment to meet their personal care needs. One resident is currently awaiting the delivery of a new specialist shower chair, with a delivery date of January 2006. The laundry is undertaken on site in a small confined area. There is no dry ironing area by the machines as part this and ironing is done in the home communal areas. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 19 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): 32,35,36 Residents are benefiting from a stabilizing of the staff that know and understand their care needs. Residents would benefit from staff working through more foundation training related to the residents care needs. EVIDENCE: The manager has reduced the use of agency staff through the use of regular casual staff employed by MCCH and recruitment to vacant posts. The same staff are booked to try to maintain familiarity for residents. The home now has 15 permanent care staff (some part time) covering the roster, with two staff on maternity leave and one staff on long term sick leave. Staff have attended in house one-day training courses relevant to core health and safety areas, further development of training in areas relevant to the residents specific care needs would be beneficial. Three staff holds NVQ 2 in care or above and two staff are still awaiting verification by the external assessors. Staff on duty today evidenced a good understanding of residents care needs through the positive relationships formed between them and residents. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 20 Rosters are covered by all staff on 24-hour basis including waking night. The home does not employ designated waking night staff. Staff confirmed they receive regular formal supervision. Auditing records sheets have been introduced to ensure regular supervisions take place and the manager is striving to achieve at least 6 within 12 months with each staff. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 21 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 Residents personal preferences support and care needs are encouraged through the registered managers open approach to managing the home and the promotion of a safe home and working environment. EVIDENCE: The registered manager has worked with this people with a learning disability for many years and has completed the Registered Managers Award NVQ 4. Residents and staff expressed a high regard for their management approach to the home. Residents felt the registered manager was approachable and staff said they felt well supported. A formal quality review of services is being planned for the New Year to gain feedback on what the home does well and what could be improved from residents who are able, their relatives or other professionals involved in their care. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 22 The registered manager demonstrated through discussion, a good understanding of the needs of current residents and current issues. Monitoring health and safety in the home is to a good standard, with weekly health and safety walking routes taking place, and equipment serviced as required to maintain a safe home and facilities. A resident was very keen to discuss the fire testing they helped with the night before and what needed to be reported. They were also undertaking fire awareness training with the designated fire warden. All food records of temperatures are maintained to a satisfactory standard. Items stored on top of wardrobes are a safety hazard and were removed by staff during this visit. Risk assessments continue to develop for individuals and staff activities in the home and care duties. Staff evidenced a clear understanding of accident/incident recording and reporting under regulation 37 to the commission. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 23 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 2 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X X 1 X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ledgers Bungalow Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000024043.V269912.R01.S.doc Version 5.0 Page 24 NO 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 YA24YA27, Regulation 23(2) (b)(o) Requirement The registered person shall having regard to the number and needs of residents ensure: That the premises to be used as a care home are of sound construction and kept in good state of repair externally and internally. In that the subsidence is assessed and remedial work undertaken, particularly in relation the large assisted bathroom where the flooring is raising and cracking causing concern of tripping and infection control hazards. This remains an ongoing requirement from the previous two inspections. Proposals to move of site fell through mid last year and no alternatives are currently being explored. Work must be competed to maintain a safe living and working environment. Timescale for action 31/01/06 Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 25 The manager evidenced Kelsey Housing agreeing to undertake the work as landlords but a completion date has not been set. Written confirmation of timescale for conmpletion and arrangemeents for residents during this work must be submitted to the commission by the timescale date. The registered person shall 31/01/06 having regard to the number and needs of residents ensure: Suitable adaptations are made and such support, equipment as may be required is provided for residents who are old, inform or physically disabled. Shower chair is currently on order and waiting delivery exopected January 2006. 3 YA24YA42 13(4) The registered person shall ensure that: All parts of the home to which residents have access to so as far as reasonably practicable are free from hazards to their safety. In that all requirements identified from previous inspection are addressed and implemented. Particularly in relation to:· The environment maintenance (subsidence and decoration)· Shower chair replaced. This links to requirements Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 26 2 YA27 23(2) (n) 31/01/06 identified in the 5 previous inspections. Written confirmation of timescale for conmpletion and arrangemeents for residents during this work must be submitted to the commission by the timescale date. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA11 Good Practice Recommendations It is recommended that additional good information seen in this large file should be referred to in the Statement of Purpose and stored to view at their leisure. The statement of purpose and residents guide should be written or presented in a format that is easily accessible and understood by the residents. It is recommended that residents be supported by relatives/ representative/advocates when drawing up the contract/ statement of terms and conditions. Particularly where they are appointees and responsible for the payment or partial payment of fees. It is strongly recommended residents are supported to express dissatisfaction to kelsey Housing regarding their responsibility to keep the home maintained and kept in a good state of repair. As detailed in their signed contracts. See requirements 3 YA6 It is recommended that the plan is made available in a language and format the residents can understand (visual, graphic, simple printed English, etc) and is held by the resident unless there is a clear (and recorded reason not to do so. Ongoing work was in evidence today. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 27 2 YA5 4 YA6 Daily write ups are more detailed in actual support and care given. Case files are tidied up , out of date letters, guidelines etc removed to avoid confusion. Basic inforamtion, risk assessments and guideines fo caer are stored with easy access. 5 YA18 6 YA20 It is strongly recommended formal records are developed and completed by staff relating to behaviours experienced. Stored in chronological order for ease of reference, montiroing and review with the challenging behaviour speciaist. It is strongly recommended that where covert medication methods have been agreed with G.P and pharmacist has clear guidelines that are sigend by all in agreement and clearly stating the reason this has been deemed in the residents best interest. MAR sheet signed by staff use two initials as single letter denotes keys for reasons not administered. MAR sheet file is tidied up. Spare blank MAR sheet is requested for additional medication ,so as clear records are in place . PRN medication is signed, amount and reason is recorded on PRN sheet as well as MAR sheet Medication policy in the MAR file is replaced with current up to date policy. New BNF is purchased for the home. 7 YA27 It is recommended that bathroom window be explored in the main bathroom to aid ventilation and lighting. From the last three inspections it was stated that Kelsey Housing have done a sight visit and due to the home proposed move, the cost of the window being inserted would not be approved. This plan has been put on hold and due to this facility being in constant use by the residents, this require reassessment and action plan submitted to CSCI of proposals to address with clear deadline and completion dates. Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 28 8 YA29 It is recommended that consent for the use of bedsides is reviewed and included in care plans as part of the next multi disciplinary review meeting. This remains ongoing through the review process. It is recommended that Mrs Parrott continues to develop written auditing/self monitoring tools in relation to daily records and practises with in the home. Ongoing work was in evidence today Once the quality assurance survey has been completed a summary of response, and action taken is frowarded to the commission and a copy held with the statement of purpose. It is recommended that a tracking sheet be devised for accidents / incidences to aid monitoring of patterns, triggers etc and whether risk assessments and guidelines need to be reviewed. 9 YA39 10 YA39 11 YA42 Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ledgers Bungalow DS0000024043.V269912.R01.S.doc Version 5.0 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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