Inspection on 12/09/05 for Maybank Residential Care Home

This inspection was carried out on 12th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Maybank Residential Care Home 06/12/07

Maybank Residential Care Home 11/12/06

Maybank Residential Care Home 07/02/06

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 ADULTS 18-65 Maybank Residential Care Home 43 Slough Road Iver Heath Bucks SL0 0DW Lead Inspector Maureen Richards Announced 12 September 2005 09:45 a.m. 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 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 Stationary 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 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Maybank Residential Care Home Address 43 Slough Road, Iver Heath, Bucks, SL0 0DW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01753 653636 john@the regardpartnership.com The Regard Partnership Limited Lawrence Mudiwa Charamba Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09 March 2005 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 facilites 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. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced. It started at 09.45 am and finished at 17.45 hours. The inspection focused on the majority of the key standards and included meeting with the service users, formal one to one meetings with two staff, talking to the registered manager and deputy manager, examining records, viewing some policies and procedures and a walk around the home. Comment cards were received from all of the service users at the home who indicated they were happy with the care they received. One comment card was received from one GP practice who stated “this was an excellent well run home”. What the service does well: What has improved since the last inspection? Service user plans have been reorganised and are more accessible. Service user plans are detailed and specific in how identified needs should be met. Service user plans include evidence of review and service users involvement. Specific and generic risk assessments are in place, which are reviewed and show evidence of service user involvement. Service users have become more involved in the day to day running of the home and this continues to be encouraged and developed on. Improvements have been made to medication practices and medication administration records indicate that systems are in place to ensure all medication administered is signed for. Some of the staff team have had adult protection training and the remainder of the staff team are scheduled to have this training this month. Areas of the home have been updated and modernised with an extension, which includes a sixth bedroom. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 6 Some improvements have been noted on staff files and files for all staff including bank staff were available at the home. Training in safe working practices have been provided and further updates are scheduled to take place. Safe working practice risk assessments have been developed. 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. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 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 standard(s) 1 & 2 The statement of purpose and service user guide provides service users with information on the home, which enables them to make an informed decision about admission to the home. The home has robust admission procedures in place, which ensures that they are able to meet the needs of service users admitted to the home. EVIDENCE: The home has a statement of purpose and service users guide in place, which has been developed in line with standard 1. A requirement was made at the previous announced inspection that the complaints procedure must be included within the statement of purpose. This has been complied with. The organisation has a separate contract. A requirement was made at the previous announced inspection that the organisation must review the contents of the service users contract regarding the arrangements for absences of over month by a service user. The sample contract seen outlined that the management had the right to let out a service users bedroom for absences of over a month. The completed contract in the service user file did not include this. The registered manager was under the impression this had been reviewed by the policy forum group and had been amended. The registered manager agreed to follow this up and make arrangements for a copy of the revised contract to be sent to the Commission. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 9 The home has had no new admissions since the previous announced inspection but has a vacancy following an extension to the home which includes a sixth bedroom. The manager confirmed that two prospective individuals have been referred for this vacancy and they were in the process of carrying out assessments on those individuals to assess their suitability. The manager has received a referral from the care manager and the manager or the referrals manager is actively involved in a full assessment prior to admission to the home. The assessment documentation was seen which is in two parts and was found to be comprehensive and in line with standard 2.3. A multidisciplinary meeting takes place prior to the service user being admitted to the home and any specialist input is agreed and accessed prior to admission. Family views are taken into consideration and where and if possible they are involved in the assessment and admission process. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 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 standard(s) 6 & 9 Service user plans are detailed and specific in plan of care, which ensures that service users needs are met. Further development of service user plans is necessary to complement this. Specific and generic risk assessments are in place which promotes the health, safety and welfare of service users. EVIDENCE: Three service user plans was seen at this inspection. The service user plans are well organised and the information is accessible. All of the service user plans seen include a photograph and a personal details information sheet with all of the key information as required under schedule 3. The service user plans include detailed and specific information on how staff support service users with their personal care needs, healthcare needs, communication needs, management of specific behaviours and or medical conditions, promoting independence and support with domestic tasks, finances and social and leisure interests. One of the service user plans made reference to the use of CPI in the management of specific behaviours. There was no explanations as to what the Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 11 abbreviation CPI meant. The manager must ensure that where abbreviations are used an explanation of the abbreviation is given. Some service user plans included a specific review date, some of the plans indicated that the review was ongoing, continuous or in three to six months. There was no date of implementation of the care plan and therefore it was difficult to establish when the review date was actually due. The manager should ensure that an actual review date is outlined on service users plans to ensure that a review takes place and that any changes in need are identified and addressed. In one service user plan there was a letter on file from the family regarding the arrangements for visitors. This must be outlined within the service user plan to ensure that all staff are aware of this arrangement and request. In one service user plan there was too much information crammed in together under specific behaviours displayed by this individual. The action to support and manage the behaviours did not follow in sequential order. The manager should address this to ensure that staff are clear on how specific behaviour should be managed. Service users plans showed evidence of being discussed with service users and signed where this was possible. Some service users plans indicated that the service user was unable to sign their plan. Each service user plan included specific and generic risk assessments. The risk assessment documentation is currently being reviewed and updated. The risk assessment outlined the level of risk and the action required to minimise the risk. Risk assessments are dated, signed by the manager and service users where possible. If the service user is unable to sign a note is made to indicate this. All of the risk assessments seen included a review date. The service user plans seen include a missing person profile which is partially completed and includes a photograph. The home has a missing person policy and procedure, which includes the date of implementation, date of next review and is signed and dated by the registered manager. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 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 standard(s) 12,13,16 & 17 Service users have an individual programme of activities and therefore their individual interests are taken into consideration. Service users are supported to take part in activities to enable them to have a community presence. Service user care files do not indicate how service users post should be managed and the toilet on the ground floor does not have a lock, which could compromise service users privacy. The home promotes service users choice in meals, providing them with a varied and balanced diet. EVIDENCE: One of the service user’s is involved in a work placement scheme on a voluntary basis. All of the service users’ have a weekly programme of activities at local day centres. Two of the service users attend day centres on a part time basis and three of the service users attend day centres five days a week. None of the current service user group are interested in taking up further education or training. Staff and or family deal with benefit queries as they arise. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 13 The manager confirmed that service users are supported and encouraged to use local community resources and leisure facilities. Two of the service users have specific one to one time on their days off from the day centres during the week and can choose what they want to do during this time. One of the service users goes to a local over 50 club and gets involved in various activities and trips out through the club. The record of activities is recorded on the daily shift planner although it is difficult to see at a glance what activities have actually taken place. The registered manager confirmed that there are no issues with neighbours. Information on local activities and events is accessed by staff and made known to service users. The home has it’s own transport and also support service users who are able to use public transport. The registered manager confirmed that all of the service users are on the electoral roll and two of the service users voted in the general election. The registered manager confirmed that staff time and support for service users is flexible and is available in the evenings and at weekends. Service user plans make reference to service users routines, choices and involvement in the decision making process. Risk assessments outline any restrictions on service users to maintain their safety. The registered manager and the induction record confirm that staff are made aware at induction how to respect privacy when entering bedrooms and bathrooms. The toilet on the ground floor does not have a lock and this must be addressed to ensure service user privacy is maintained. Service users bedrooms are lockable however the majority of service users do not have a key to their bedroom or front door and a risk assessment is in place to support this decision. One service user has recently been given his bedroom key and staff are working with him in being able to have a front door key. The registered manager confirmed that staff do not open service users post. Some service users require support to open and deal with their post. There is no reference to this in service user plans. Service user plans must outline the level of support required by individuals in managing their post. Service users were noted to be called by their names as outlined in the service user plan. Staff were observed interacting with service users and supporting them to communicate their needs. Service users can choose when to be alone or in company and during the inspection one service user choose to spend time in his bedroom. Service users have unrestricted access to the home and grounds however they are all supported when leaving the home. Service user plans make reference to support required in cleaning their bedrooms. Service users are not responsible for cleaning communal areas of the home. The organisation has a policy on pets. The decision to have a pet is assessed individually by each home. The home is currently considering getting a small pet for example a bird. Service users are not allowed to smoke in any area of the home. None of the current service users smoke so this is not an issue. Any prospective service Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 14 users would be made aware of this at the point of assessment and prior to admission. Service users have three meals a day with drinks and snacks being available as required. Service users make individual choices for breakfast and lunches. The majority of service users take a packed lunch to the day centres. The home has a four weekly evening meal menu and the actual weekly menu is planned and agreed at the weekly service users meetings. Service user meeting minutes seen support this. A separate record is kept of the actual meal eaten which indicates alternatives are provided for individuals and service users individual choices, likes and dislikes are taken into consideration. The registered manager and deputy manager confirmed that pictures are used to assist choices. The menu plan seen was found to be varied and a requirement made at the previous announced inspection for all meat and fish dishes to be probed was found to be complied with. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 15 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 standard(s) 19 & 20 The home has records in place, which indicate that service users’ health care needs are met and monitored. Improvements have been made to medication practices, however some medication practices compromises the health and safety of service users. EVIDENCE: The service user plans seen make reference to the support required with healthcare needs. A record is maintained of all healthcare appointments and the outcome. All of the service users are registered with local GP surgeries. Service user plans make reference to the level of support required in managing incontinence and the home can access a continence advisor through the GP if required. Service users are offered routine screening. The home has one service user with epilepsy and clear guidelines are in place as to how this should be managed. Service users are supported to attend the dentists, chiropodist and opticians. Staff and or family support service users to attend any healthcare appointment. The registered manager confirmed that all of the service users have an annual health check with the practice nurse. None of the current service user group are self-medicating and therefore staff are responsible for the administration of all of the service users prescribed Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 16 medication. The home uses the Boots monitored dosage system. The medication administration records indicate that there was no gaps in administration and two staff sign to confirm that the medication has been administered. The medication cupboard is well organised although external medications for example shampoos and creams are stored with internal medications. The manager should address this. A requirement was made at the previous unannounced inspection that staff responsible for overseeing medication are made aware to check and record the amount of medication received into the home. This has been complied with and all medication received into the home is recorded on the medication administration record. Some medication is not ordered or required each month and a note is made on the medication administration record to indicate this and to indicate the amount of medication carried forward from the previous month. Staff are signing to confirm this in the boxes for signature to indicate administration, which is misleading and could indicate the medication has been given. This must be addressed. A requirement was made at the previous unannounced inspection that the manager must review the list of homely medication and ensure that any homely remedies stocked by the home do not interact with service users prescribed medication. The registered manager wrote to the GP and the GP confirmed in writing that paractemol and gavison could be used as homely remedies as they do not interact with prescribed medication. The manager confirmed that he has made the decision not to have any homely remedies and if paractemol or gavison is required a prescription and or permission would be requested from individuals GP’s to request this. The manager must consider how a request from service users for pain relief out of hours will be addressed and a protocol must be put in place to support this. A requirement was made at the previous unannounced inspection that the manager must ensure that all medication prescribed is listed on individuals medication administration records and discontinued medication to be disposed back to the pharmacy. This has been complied with. A requirement was made at the previous unannounced inspection that the manager must ensure that all out of date medication is disposed of and systems must be put in place to ensure that dates are checked on medications on a regular basis. This has been complied with and there was no out of date medication in stock. The home has a disposal of medication record in place, which are loose sheets of paper, which can be removed or tampered with. This must be addressed and a system put in place to ensure that safe accurate disposal of medication records can be maintained. One service user goes on leave to his family on a regular basis. Staff decant the medication from the blister pack into a dosette box. This is not in line with pharmaceutical guidelines or the organisation’ s policy. This practice must cease with immediate effect and the home must liaise with the pharmacy on how this can addressed. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 17 The home has medication guidelines in place, which need to be updated in line with recent pharmaceutical guidelines. The home has a copy of the organisation’s medication administration policy, which is overdue for review. Staff’s induction checklist confirms that individual staff have been assessed and are considered safe to administer medication. Some staff have had care of medicines training and the registered manager confirmed that another training session is being organised for the new members of the team. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 18 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 standard(s) 22 & 23 The home has an effective complaints procedure in place, which ensures that service users concerns are listened to and acted on. The home has robust procedures and training in place, which ensure the protection and safety of service users. EVIDENCE: The home has a complaints procedure in place, which indicates that all complaints will be dealt with within 28 days. The service users guide includes a copy of the complaints procedure and a pictorial complaints procedure is displayed on the notice board in the sitting room. Service users are asked individually at the service users meetings held weekly if they have any complaints and a record is made of their response. Service users are also encouraged to discuss any issues with their keyworkers during their monthly key worker one to one sessions. One service user’s relative indicated that they were not aware of the complaints procedure although they indicated they had made a complaint. The home keeps a record of all concerns, issues and complaints raised with a record of the outcome of the investigation into the complaint. The registered manager confirmed that the home has an abuse awareness and whistle blowing policy in place. The whistle blowing policy was displayed on the office notice board. Completed staff induction checklists indicate that new staff are expected to read and confirm that they have understood the policies. The manager has obtained copies of interagency adult protection procedures as required at previous inspections. Staff spoken with confirmed that they are aware of their responsibilities in reporting bad practice and abuse. Six of the staff team had POVA training in 2004/2005 and a further six staff have been identified to attend this training which is scheduled to take place on the 20th September 2005. A requirement Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 19 was made at the previous announced and unannounced inspection that all staff must have up to date abuse awareness and adult protection training. This will be complied with following the training on the 20th September 2005. The home has had no incidences of allegation of abuse since the previous unannounced inspection. The home has guidelines in place in individual service users plans on the management of physical and verbal aggression. The organisation includes CPI as part of their mandatory training. The majority of the staff team have had this training. Service users have an appointee responsible for looking after their money and dealing with benefit issues. The registered manager confirmed that the home looks after service users personal allowance money and all money spent is accounted for and reconciled against individuals record. These records were not seen at this inspection. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 20 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 standard(s) 24, 26 & 27 The home is welcoming, well maintained, bright, and clean and provides a safe and homely environment for service users. EVIDENCE: The home is accessible and well maintained. The home has had an extension to include a sixth bedroom, which also includes a modern fitted kitchen and a conservatory, which is used as a dining room. One of the upstairs bedrooms have been extended to allow for a wardrobe and includes an en suite shower room. New furniture has been purchased for the sitting and dining rooms and those areas appear modern, bright and homely. The registered manager confirmed that blinds are on order for the conservatory and that the carpet in the sitting room, stairs and landing is scheduled to be replaced the week following the inspection. There is a step down from the sitting room into the conservatory. This has been identified as a trip hazard and risk assessments are in place to reduce the risk to service users. The manager confirmed that quotations have been requested for a ramp to be fitted in this area but no date has been confirmed for this work to take place. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 21 The majority of the doors have overhead door closures or door guards in place. Following a recent fire inspection a requirement was made for the door guards to be removed from the kitchen door, the door from the sitting room into the stairway and from the new bedroom door. This has been complied with and overhead door closures are now in place in those areas. A requirement was made by the fire authority for risk assessments to be put in place where door guards were used. The registered manager confirmed that this has been complied with and has agreed to send the Commission a copy of those risk assessments. The door guards are checked weekly as part of the fire point check. All of the service users bedrooms were seen at this inspection. The bedrooms were found to be clean, personalised and adequately furnished. Five of the bedrooms have a sink in the room and one of the bedrooms has an ensuite toilet, sink and shower. The home has a walk in bathroom downstairs with a toilet and a sink. There is a single small toilet downstairs and as outlined in standard 16 this toilet did not have a lock to maintain privacy. This toilet does not have a sink for service users to wash their hands after using the toilet. The organisation need to consider how infection control can be managed. There is a further toilet and disabled shower on the ground floor. There is a separate bathroom and toilet upstairs. Both of those areas are clean but could be considered for updating. Standard 30 was not fully assessed. The home has a separate laundry with entrance to the laundry from the outside. An outside light has been fitted to the outside area to ensure that this area is well lit, safe and accessible to service users and staff. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 22 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 35 Some improvements have been made to staff files however there are still some shortfalls in the recruitment practices, which could compromise the safety and well being of service users. The majority of staff have up to date safe working practice training, however there is a lack of specialist training to support staff in their roles and to enable them to meet service users identified needs. EVIDENCE: Standard 33 was not assessed however feedback from one staff member indicated that staff felt that there was not enough support hours allocated to enable them to do their job effectively whilst meeting service users changing needs. Support staff are expected to do the cooking, cleaning and shopping and work split shifts due to service users being out of the home for three days of the week. This was feedback to the manager who is asked to discuss those concerns with the staff team and address accordingly. The manager confirmed that extra funding has been obtained which provides an extra staff member from 20.00 hrs to 22.00 hrs each evening. The rota reflects this. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 23 Five staff personnel files were seen at this inspection. Two of the files were found to be well organised and accessible, the other three files were disorganised and information was not easily accessible. All of the staff files seen contained personal details with next of kin, a completed health questionnaire, terms and conditions of employment, copies of identity for example driving licence, birth certificate and passport. Some of the files contained an up to date photograph and some of the files contained a photocopy of passport where the photograph was not clear and was not up to date. All of the staff files contained an up to date CRB clearance and evidence of a POVA check being carried out whilst waiting for CRB clearance. Three of the staff files contained a copy of a work permit/visa’s. In one file the visa had expired in 2003. There was a letter on file from the home office dated July 2004 to indicate they had received the application and it advises that if the application was made before the previous visa expired that the individual had the same rights to remain in the United Kingdom. The letter from the home office does not indicate the date of the application and therefore it was not established if those same rights apply. The registered manager must have written confirmation on file of the date of the application to the home office to confirm that this visa is valid. Four of the staff files seen had two references on file. On one of those files the referee did not correspond with the work history on the application form. The registered manager was unable to explain this. The staff member was on duty and was able to confirm that the referee was from a previous employer but this referee had since changed jobs and at the time the reference was written he no longer worked for that company. One of the staff had been promoted internally from support worker in one home to a senior support worker at Maybank. There was no application on file to indicate that this individual had applied for this position and there was no up to date reference on file from this individuals previous manager to confirm that they were suitable for this post and extra responsibilities. The manager must ensure that those shortfalls in the recruitment practices are addressed. The majority of staff have up to date safe working practice in fire safety, first aid and food hygiene. The majority of the staff team are overdue for an update in moving and handling training. The registered manager confirmed that this training is booked for October 2005. All new staff undergo in house induction training and a comprehensive induction checklist is in place to support this. Each staff member had an individual record of training and the manager has a list of all training undertaken by staff and is able to identify when updates are due and request specific training. The home has two staff who have attended epilepsy training but no other specialist training has been provided. The home has two service users with dementia and training in dementia and epilepsy must be provided to support staff in their roles. The registered manager confirmed that he has identified that this specialist training is required but that the mandatory training has been a priority to provide. Some staff have been Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 24 registered on an NVQ and are due to commence this training in December 2005. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 25 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were assessed at this inspection. EVIDENCE: Standard 42 was not assessed. Requirements were made at the previous unannounced inspection that the manager must carry out a risk assessment for all of the service users against the risk of scalding from radiators and appropriate action taken to minimise identified risks. Service users plans include risk assessments and radiator covers are fitted for one service user as felt necessary. A requirement was made at the previous unannounced inspection that the manager must ensure that risk assessments are carried out for all safe working practice topics and that significant findings of the risk assessments are recorded. Risk assessments have been completed and this requirement has been complied with. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 26 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 3 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 2 x x x Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Maybank Residential Care Home Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 27 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 6 Regulation 15 Requirement The manager must ensure that abbreviations used in service user plans are fully explained to ensure that all staff are clear on how situations should be managed. The manager must ensure that the arrangments for visitors as requested by one service users next of kin is outlined clearly within the service users plan. Service user plans must make referance as to how individual service users post is managed. The toilet on the ground floor must have a lock fitted to the door to ensure that service users privacy is maintained. The manager must consider how a request from a service user for pain relief out of hours will be addressed and a protocol must be put in place to support this. A tamperproof disposal of medication record to be put in place. Staff must not decant medication from the blister packs into dostte boxes. The manager must liase with the pharmacy on how medication required for leave is 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Timescale for action 1/10/05 2. 6 15 1/10/05 3. 4. 16 16 12 12 31/10/05 30/09/05 5. 20 12 15/10/05 6. 7. 20 20 13 13 31/10/05 30/09/05 Maybank Residential Care Home Version 1.40 Page 28 to be managed. 8. 34 19 The manager must ensure that all staff files contain the relevant information as outlined in schedules 2 & 4(6). (previous timescale of 30/04/05 not met) Specialist training on dementia and epilepsy must be made available to the staff team. 31/10/05 9. 35 18 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 6 6 20 20 34 27 Good Practice Recommendations The manager should ensure that service user plans include the actual date of review and not that the review is on going, continous or in three to six months. The manager should ensure that service user plans clearly outline behaviours and managements of those behaviours. Staff should not sign on the signature boxes on the medication administrtion records that medication has been carried over from the previous month. The manager should obtain a copy of the up to date pharmaceutical guidelines and medication guidelines and practices to be updated in line those guidelines. All staff files should be reorganised and made accessible. The organisation should consider how good hygiene can be promoted where the toilet does not have a sink. Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 Page 29 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close, Aylesbury, Bucks, HP19 8JR 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 Maybank Residential Care Home 120905_Maybank_AI_Stage 4_S59317_V242119_H53_H02_MR_ces.doc Version 1.40 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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