Inspection on 11/12/06 for Maybank Residential Care Home

This inspection was carried out on 11th December 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maybank Residential Care Home 06/12/07

Maybank Residential Care Home 07/02/06

Maybank Residential Care Home 12/09/05

Maybank Residential Care Home 09/03/05

Maybank Residential Care Home 08/09/04

Maybank Residential Care Home 20/01/04

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Maybank Residential Care Home 43 Slough Road Iver Heath Bucks SL0 0DW Lead Inspector Gill Gentles Unannounced Inspection 11th December 2006 09:30 Maybank Residential Care Home DS0000059317.V316896.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 Maybank Residential Care Home DS0000059317.V316896.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 Older People and 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. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maybank Residential Care Home Address 43 Slough Road Iver Heath Bucks SL0 0DW 01753 653636 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) The Regard Partnership Limited Lawrence Mudiwa Charamba Care Home 6 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (1) of places Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Disability Included in the six service users with learning disabilities, the home can accommodate one service user with a physical disability. 7th February 2006 Date of last inspection Brief Description of the Service: Maybank is a care home providing personal care and accommodation to five service users with a learning disability. The home is owned and managed by the Regard Partnership Ltd. The home is located in Iver heath, which is accessible to local shops including a post office and public house. Other facilities and interests are accessed by car. The home is a large chalet type bungalow, which has been extended on over the years. All of the bedrooms are single. The home has a secure large rear garden and a driveway at the front of the property. The current fees for this home range from £945.57 - £1475-05 per week. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took place on the 11th December. Policies, procedures, home records and care records were examined. The acting home manager, service users and staff were spoken to. Interactions between Service Users and staff were observed. All service users were communicated with throughout the course of the inspection. The care of three Service Users was case tracked and care practices were observed. Documentation pertinent to the health and welfare of Service Users and health and safety around the home were viewed. A tour of the environment pertinent to the three service users being case tracked was carried out, this included bedrooms, bathing and toileting facilities as well as the communal areas. The commission did not receive any comment cards from any Service Users, relatives or health care professionals. The manager did hand to the inspector filled in questionnaires from the service users which had been completed by members of the staff team. The evidence seen and comments received indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals. What the service does well: The home appears to be managed well by the acting manager giving clear leadership to the team and promoting continuity of care to service users. Health and safety procedures are carried out appropriately ensuring service users are not placed at any risk. Personal care needs of the service users are identified through the Care Plans to ensure individual needs are met. Risk Assessments are in place to ensure service users are safe. The home offers a range of activities in the community, which provides opportunities for stimulation and involvement. Service users are supported to maintain contact with family and friends, to keep important social contacts. The home ensures that they cater for all service users specialist needs offering balanced and nutritious meals. Service users are offered personal, physical and emotional support as and when required and records are clearly maintained. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 6 The home’s recruitment policy and practices support and protect service users from potential harm. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. A policy and procedure is in place to ensure prospective service users are thoroughly assessed to ensure the home can meet their needs. However, there are shortfalls in documentation, the home has no evidence to support the fact that new service users are compatible with existing service users in the home EVIDENCE: The home has a Statement of Purpose and Service Users Guide in place that has been reviewed since the last inspection, however service users do not have their own copies. The home has had one new service user since the last inspection took place. Records show that there is a needs assessment that had been carried out by Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 9 the local authority prior to the move. There was no evidence to support that the home had carried out its own assessment by having tea and overnight visits, and whether the home could and would be able to meet the individuals needs or that the prospective service user is suitable and compatible with the existing service users group. The new service user was not in during the inspection until late afternoon and refused to talk when she arrived home. However, a “have your say about” survey was completed, which identified that this individual had not been asked if she/he wished to move into the home but felt they had received enough information to help them decide. The home according to the pre-inspection questionnaire submitted by the manager has an admissions policy, which was updated in December 05. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Personal care needs of the service users are identified through the Care Plans to ensure individual needs are met. Risk Assessments are in place to ensure service users are safe. EVIDENCE: Three service users care was tracked as part of the inspection visit. Due to the complex needs of individuals it was not possible to communicate verbally with Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 11 a high percentage of service users to ascertain service users views on their plan of care. Service users care plans were found to be basic with a negative bais. This was discussed with the manager during the course of the inspection. Headings such as “problems” “ issues” were being used. Having said all this the files were easy to read and clear in direction. Strengths, goals and interventions were incorporated for each individual. The Care Plans also incorporated infomratin relating to : • Health care • Behavioural guidelines • Likes and dislikes • Strengths e.g. “Brushes own hair” and “can make own cup of coffee” • Annual reviews The plans need to be developed further as their was little or no evidence that service users are involved in their development and that their preferences and wishes are clearly being addressed. Risk Assessments are completed for all service users and held in their personal file and inparticular for the three being case tracked. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 13 The home offers a range of activities in the community, which provides opportunities for stimulation and involvement. Service users are supported to maintain contact with family and friends, to keep important social contacts. The home ensures that they cater for all service users specialist needs offering balanced and nutritious meals. EVIDENCE: Due to the disabilities of the service users, opportunities are not really available for employment, however the three service users case tracked have the opportunity to attend day centres in Buckinhamshire and Berkshire. The service users living in this home have complex and diverse needs, as well as communication difiiculties and behavioural challenges that arise from time to time. The acting manager has produced new activity timetables in conjunction with the key-workers. It was not clear at what level service users were invovled. The activity planner is flexible and gives a guide to each days activities. There is an alternative list if service users refuse to take part in their chosen planned activity. Each service user has a copy on the wall in their bedrooms and there is one on the inside of the office. The three service users whose care was tracked all do differnet things. Two attend day centres and one lady said she is “retired”. However chooses to attend a over 50’s ladies group for 2.5 hours per week. This took place on the day of the inspection visit. One gentleman works at a centre doing horticulture. Staff and service users confirmed that they go out for meals and one gentleman on the day of the visit had been out with a carer for lunch at a pub. Recent event was to the pantomime in Windsor. Family and friends contact is supported and encouraged. Visitors are welcomed into the home. Service users take little or no responsibilty for the day to day running of the home directly although staff do encourage joining in of activities in the kitchen a little cleaning in their rooms or taking washing to the laundry room. One gentleman whose care was being tracked has a keen interest in health and safety checks being carried out and discussions took place with the manager and service user during the visit about utilising his skills and interests e.g. involvement in the monthly health and safety audit etc. The homes staff prepare and cook all the meals and menus were seen for the previous and coming week. The home seemed to offer a well balanced nutritious diet. The fridge, freezer and cupboards were well stocked offering arrange of fresh and frozen foods. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Service users are offered personal, physical and emotional support as and when required and records are clearly maintained. Medication is managed well, ensuring that service users receive the medicines they require to keep them healthy and well. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 15 EVIDENCE: All Care Plans of the three-service users case tracked identified their personal support needs and specific action for the staff team to ensure service users needs are being met. Service users are supported to access medical professionals through either the GP or the Community Learning Disability Team. A record of health care appointments, are maintained for those service users who have attended routine doctors, dental, optical appointments with a brief descriptions of the outcome. Medication policies and procedures are in place and accessible by all staff all documents were reviewed by the organisation in December 05 according to the managers pre-inspection information. Clear guidelines for each service user are in place for administering all medication including PRN medicines. Medication is stored in a lockable cabinet on the wall in the office. Medication for the three-service users case tracked was found to be stored adequately with appropriate documentation being in place. Medication is ordered by a delegated member of staff, who was able to explain the system for ordering and returning medication. Boots the chemist delivers all medication in a sealed bag and audits the home’s storage and recording systems on a quarterly basis. General discussions took place with staff regarding the administration of medication and good practice issues. Staff seemed to have knowledge and understanding of their legal responsibilties in relation to correct administration. The home does not have any homely remedies or over the counter medicines in the home all medication is prescribed by the GP even for colds etc. Medication Administration Records were viewed and found to be free from errors or gaps at the time of the visit. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. There is an effective complaints and adult protection policy and procedure in place to ensure that issues raised by service users and their representatives are listened to, however shortfalls have been identified and addressed adequately to safeguard service users from abuse. EVIDENCE: Since the previous inspection the home, organisation and Commission for Social Care Inspection have received complaints from family members and the local authority’s. These complaints also indicated that there are adult protection issues that needed investigating. The Protection of Vulnerable Adults concerns were referred through the appropriate channels such as the local authorities safeguarding team, the police and the Commission. Notifications were made to the Commission In relation to possible financial irregularities, allegations of neglect, complaints about staffing, communication and not meeting service users health care needs. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 17 Evidence indicates that all investigations and strategy meetings have been carried out appropriately by all agencies involved and the outcome is recorded and copies were forwarded to Commission for Social Care Inspection. Appropriate action has been taken by the provider of the service to ensue appropriate management of the home to ensure the safety and protection of service users. Records viewed for all staff indicate that although there have been some serious allegations of abuse in the home there has not been any training made available to ensure staff are up to date with current knowledge and legislation etc. Training records indicate that none of the seven permanent and five bank staff are trained. Records show that four have been identified to attend training in January 07. The manager confirmed verbally that three staff had recently attended training but certificates had not arrived. It is required, especially in the light of this homes history that all staff including bank staff are trained in safeguarding adults from abuse. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. In general the home was found to offer a homely ambience, shortfalls were noted in areas where the décor is dated and old-fashioned. Hygienic issues need to be addressed to ensure cross contamination does not take place. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home is situated in Iver Heath near Slough. There are local shops and recreation facilities such as a pub within easy distance. The home is an extended dormer bungalow that accommodates six service users on two floors. There is a decent sized kitchen to meet the needs of the home, a lounge and conservatory that doubles up as a dining room. There are three bath/shower rooms and five toilets in the home. The rooms pertinent to the three-service users case tracked were toured along with communal areas. A service user who seemed to enjoy discussing improvements that had been made and areas that need addressing gave the tour of the building. Rooms were not entered without permission and respect was shown for other service users belongings and personal space. Overall the home was found to be clean and tidy some areas are in need of painting such as woodwork around the communal areas. The décor is slightly dated and in need of modernisation. It was acknowledged that where possible staff had worked hard to dress up rooms with service users involvement to give them a more modern feel. The down stairs shower room was found to be in a poor state, service users were concerned that the toilet wobbled about, upon inspection it was evident that the toilet was not fitted to the floor properly, the flooring was badly stained and their was a slight odour detected which must be addressed. One of the toilets does not have a wash hand basin and therefore failing to eliminate cross infection and contamination and must be installed. It was noted at the previous inspection that clinical waste was being disposed of in the ordinary bins. The acting manager has addressed this and a clinical waste wheelie bin is now in situ. Training records indicate that no staff have received training in the control of infection. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy and practices support and protect service users from potential harm. The number of the staff have received training in the mandatory health and safety courses, however, shortfalls are identified placing service users in some risk. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 21 EVIDENCE: Personal records were viewed for new staff (permanent and bank) working in the home . All files contained the appropriate information required to ensure service users are protected from harm. The staff · · · · · mandatory training of the permanent staff is low, out of seven permanent there are:Food Hygiene - 2 Fire Awareness - 3 First Aid - 3 Manual Handling - 3 Infection Control – 0 The acting manager was able to evidence that he has requested training for Fire Safety and First Aid which is planned to take place in January 07. there was no evidence that the other shortfalls were being addressed. The manager must ensure that all staff receive the appropirtae and adequate mandatory training. Other training is promoted and encouraged, these include Risk Assessment, report writing, communicqation and non-violent crisis intervention. The acting manager confirmed that all staff ae enrolled on NVQ courses, however there is a shortage of assessors through Thames Valley University where the staff are enrolled so they have not continued or been completed. The acting manager has completed NVQ level 3 and is awaiting to hear whether he has passed. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome are is good, This judgement has been made using available evidence including a visit to this service. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 23 The home appears to be managed well by the acting manager giving clear leadership to the team and promoting continuity of care to service users. Health and safety procedures are carried out appropriately ensuring service users are not placed at any risk. EVIDENCE: At the time of the inspection the home has an acting manager who was ensuring the smooth running of the home following Protection of Vulnerable Adults issues and the previous manager leaving. The organisation has advertised the position and is in the process of recruiting a permanent manager. By talking with staff and observing interactions with the acting manager it was evident that he has an open and transparent style with the staff on duty being involved in the running of the home. All staff spoken with had a clear unsderstanding of how the home operates and communication between each other was observed as being of a high standard. The home had a quality audit completed in August this year. Regular proprietors unannounced visits take place monthly and records were available for perusal. A selection of health and safety certificates was perused, such as fire, gas and portable appliances and found to be in date and regularly checked. The accident incident records of the three service users whose care was tracked evidenced appropriate recording systems being in place to ensure service users are protected. One-service user has had four incidents since the last inspection and all were managed and recorded appropriately. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 X 40 X 41 X 42 3 43 X 2 2 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Maybank Residential Care Home Score 3 3 3 X DS0000059317.V316896.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5(1) Requirement It is required that the manager ensures all service users and or their representatives are issued with a copy of the Service Users Guide. It is required that the manager evidences that new/prospective service users are assessed appropriately and consideration is given to the compatibility with existing service users. The care plans need to be developed further as their was little or no evidence that service users are involved in their development and that their preferences and wishes are clearly being addressed. It is required that all staff including bank staff are trained in safeguarding adults from abuse. The manager is required to ensure that the downstairs shower room is repaired and made safe and that a wash hand basin is installed in the toilet. DS0000059317.V316896.R01.S.doc Timescale for action 31/01/07 2 YA2 14 31/01/07 3 YA6 15 28/02/07 4 YA23 18(1) 28/02/07 5 YA24 23(2) 15/03/07 Maybank Residential Care Home Version 5.2 Page 26 6 YA35 18(1) The manager is required to ensure that all staff receive the appropriate health and safety mandatory training. 30/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Maybank Residential Care Home DS0000059317.V316896.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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